True Diverticulum Research Articles

Combined Laparoscopic–Endoscopic Technique for Gastric Diverticulectomy

Purpose: Gastric diverticula are rare manifestations of diverticular disease, accounting for 3% of all diverticula. Methods: We present the case of a 17-year-old male who presented with complaints of epigastric fullness, reflux, and early satiety. He was given a trial of proton pump inhibitors with minimal improvement. A contrast swallow study showed an irregularity at the gastric fundus. A gastric diverticulum was confirmed on endoscopy and the patient was referred to surgery. Resection was planned because of symptomatology. Utilizing laparoscopic–endoscopic rendezvous technique, the posterior lying diverticulum was resected. A nasogastric tube was placed postoperatively and the patient was kept nil per os for 24 hours. He was advanced to a diet and discharged home on postoperative day 3. At follow-up he has no complaints. Results: Gastric diverticula are uncommon manifestations of diverticular disease. These lesions have equal incidence in males and females and occur in pediatric patients only rarely, 4%. Gastric diverticula may be congenital or acquired. Congenital gastric diverticula are true diverticula, occurring posteriorly within 2–3 cm of the gastroesophageal junction and are thought to arise from a defect in the gastric wall musculature. Patients with congenital diverticula are often asymptomatic or present with vague abdominal complaints, thought to be because of their location and broad base. Emergency complications include bowel obstruction, perforation, or bleeding. Oral contrast swallow studies and upper endoscopy provide the most reliable diagnosis; however, many patients will undergo CT or ultra sound imaging because of their vague complaints, and these lesions are often confused for splenic, adrenal, or pancreatic pathologies. Conclusion: Gastric diverticula are rare congenital abnormalities in pediatric populations. Resection is recommended for resolution of symptoms. A laparoscopic–endoscopic rendezvous procedure allows for adequate identification and observation of the lesion. No competing financial interests exist. Runtime of video: 3 mins 16 secs A version of this video was previously presented at the American College of Surgeons Meeting in Washington DC, October 19, 2016.

Ventricular pseudodiverticula from intraparenchymal cerebrospinal fluid dissection secondary to high-grade obstructive hydrocephalus in children: magnetic resonance imaging findings.

We report on a series of three children who presented with a focal cerebrospinal fluid collection within the periventricular white matter of the temporal and occipital lobes in the setting of high-grade obstructive hydrocephalus. Magnetic resonance imaging showed a focal defect within the ventricular wall associated with leakage of cerebrospinal fluid into the adjacent white matter. The white matter tracts appeared primarily displaced. This entity should be referred to as ventricular pseudodiverticulum, not lined by ependymal cells, in contrast to a true ventricular diverticulum in which the cerebrospinal fluid is contained by a focal outpouching of the intact ventricular wall lined by a dilated and prolapsed layer of ependymal cells. Correct interpretation and classification of the findings may be helpful in predicting prognosis and outcome.

Congenital Jejunal Diverticular Bleeding in a Young Adult.

Diverticular bleeding of the small bowel is rare and occurs primarily in adults aged more than 60 years. In younger adults, Meckel’s diverticulum, a true diverticulum that congenitally occurs in the distal ileum, is the most common cause of diverticular bleeding of the small bowel. Unlike Meckel’s diverticula, other kinds of small bowel diverticula are not congenital and their incidence is related to age. Furthermore, congenital true diverticular bleeding of the jejunum in adults is very rare. We report the case of a 24-year-old man with subepithelial tumor-like lesion accompanied with obscure overt gastrointestinal bleeding. This lesion was initially suspected to be a subepithelial tumor based on radiologic tests and capsule endoscopy. He was finally diagnosed with a congenital true diverticulum in the jejunum with the appearance of a Meckel’s diverticulum after surgical resection.

Torsion and inflammation of Meckel's diverticulum: Rare cause of acute abdominal pain

Abstract Meckel's diverticulum is a remnant of the embryologic vitelline duct. It was named after its anatomical and embryological description, in the early 19th century, by Johann Meckel. It is known as a true diverticulum of the small bowel and is typically estimated to be present in 2% of the general population, with only a very small percentage being symptomatic. In this report, we present a 14-year-old boy with complaints of abdominal pain, fever, nausea, vomiting and diarrhea. During physical examination we observed peritoneal irritation and raised inflammatory markers. Surgical exploration revealed torsion and inflammation of a large Meckel's diverticulum with a gangrenous area. In order to ensure the removal of etopic tissue, if present, segmental bowel resection with primary anastomosis was performed. Histopathological analysis did not find ectopic tissue. The operative and postoperative courses were uneventful. Meckel's diverticulum is an important differential diagnosis in acute abdominal pain in children.

Tracheal Diverculum: A Rare Entity Diagnosed in the Context of Blunt Thoracic Trauma Report of A Case

Tracheal diverticulum (TD) is an outpouching or sac arising from the wall of the trachea. It can can be classified, based on etiology, in congenital and acquired. Congenital tracheal diverticulum is the consequence of a defect in endodermal differentiation of the membranous posterior tracheal wall and it contains all the layers of the airway wall (true diverticulum). Acquired diverticulum is the result of an abnormally increased pressure inside the airways pushing the respiratory mucosa out of a defect of the airway wall; it contains only mucosa (pseudodiverticulum). Both types are rare, accounting only for a limited percentage of the paratracheal air cysts (PTACs) from which TD should be differentiated in consideration of the similar basic pattern of “paratracheal air collection”. Diagnosis of TD is difficult because of its rarity, lack of symptomatology or specific symptomatology and low sensibility of the diagnostic tools available to date (chest CT and bronchoscopy). Apart from its intrinsic rarity, the case of TD we present here has the peculiarity of being diagnosed, differently from usual, by direct bronchoscopic visualization. The blunt thoracic trauma of which the patient was victim, gives more exemplarity to the diagnostic pathway of this entity. Indeed the detection of a para tracheal air collection on CT images could have been interpreted as a traumatic rupture of the trachea rather than a TD, leading to an unjustified surgical treatment. It was only clinical judgment combined with the use of the diagnostic imaging and bronchoscopy that conducted to the correct diagnosis.

Many faces of Meckel’s diverticulum and its complications

Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It is a true diverticulum containing all layers of the intestinal wall and identified as a saccular, blind-ending structure located on the antimesenteric border of the distal ileum. Most patients remain asymptomatic during their lifetime. Symptomatic cases are nonspecific and can present as small-bowel obstruction, diverticulitis, perforation, gastrointestinal bleeding, and rarely, a neoplasm. Therefore, the radiological diagnosis is of paramount important for proper patient management.

Intraoperative diagnosis of cecal diverticulitis during surgery for acute appendicitis: Case series.

Cecal diverticulum is a rare entity, and can cause acute abdomen by the way of diverticulitis and perforation of diverticulitis. In this study, we aimed to perform an analysis of patients that have cecal diverticulitis, and presented with acute abdomen. Patients who were admitted to emergency clinic between 2009-2012 and had acute abdomen due to cecal diverticulitis were included into study retrospectively. Six patients were included in the study with a mean age of 34 years (range 24-43). Four patients were male and two were female (male/female: 2). All six patients presented with abdominal pain, additional symptoms were nausea in five patients, and vomiting in one patient. The mean white blood cell count was 11.900/mm(3) (5850-17.400/mm(3)), while the remaining laboratory results were normal. There were no specific findings on abdominal X-ray or ultrasonography. The surgical exploration revealed an inflamed cecal diverticulitis and normal appendix in all patients. Five patients underwent appendectomy and diverticulectomy. Right hemicolectomy was performed in one patient due to suspicion of malignancy. The early postoperative period was uneventful in all patients. The mean length of hospital stay was 4.5 days with a range of 2-6 days. Histopathological examination showed acute perforated diverticulitis with underlying true diverticulum in three patients, and true diverticulum with acute diverticulitis in the remaining three patients. Pre-operative diagnosis of cecal diverticulitis is challenging due to symptoms and signs that resemble acute appendicitis. Diverticulectomy and incidental appendectomy is the treatment of choice in uncomplicated cases.

Chronic gastritis in a gastric diverticulum misdiagnosed as a left adrenal mass.

Gastric diverticula are rare and usually asymptomatic. They are most frequently located on the posterior wall of the stomach. Many of them were reported as adrenal masses. Here, we present a 48-year-old male with a gastric fundus diverticulum that was misdiagnosed as a left adrenal mass on magnetic resonance imaging (MRI). Laparoscopic resection of the diverticulum was successfully performed, and histopathological examination revealed a true gastric diverticulum with moderate chronic gastritis. Although most cases of gastric diverticula are asymptomatic, to the best of our knowledge, this is the first reported case of chronic gastritis that developed in a gastric diverticulum.

上行結腸憩室出血を同時に併発した虫垂真性憩室出血の1例

上行結腸憩室出血を同時に併発した虫垂真性憩室出血の1例

English

BACKGROUND: Although Meckel's diverticulum is the most prevalent congenital abnormality of the gastrointestinal tract; it has varied presentations and often becomes a diagnostic challenge. PATIENTS AND METHODS: This was a retrospective study of all children who had underwent surgery for Meckel's Diverticulum in the department of Pediatric Surgery, S. Nijalingappa Medical college and H.S.K Hospital, Bagalkot between February 2009 and February2013. RESULT: A total of 17 patients (10male and 7 female) aged from 1month to 13 years with a diagnosis of Meckel's Diverticulum were evaluated and analyzed, looking at age, gender, clinical features, investigations, histopathological findings and surgical interventions. All patients were symptomatic and presented with various clinical features like intestinal obstruction(29.4%), perforated Meckel's Diverticulum(23.5%), diverticulitis(17%), intussusceptions(11.7%), patent vitellointestinal duct ( Meckel's prolapse) (11.7%), Littre's hernia(5.8%). All the cases were investigated and underwent surgical intervention Meckel's diverticulectomy/ resection anastomosis and were followed up. Most common post-operative complication was wound infection. CONCLUSION: A Preoperative diagnosis of complicated Meckel's Diverticulum may be challenging because of the overlapping clinical and imaging features of the other acute surgical and inflammatory conditions of the abdomen, hence it is necessary to maintain a high incidence of suspicious in the pediatric age group. INTRODUCTION: Meckel's diverticulum (MD) is one of the most common congenital abnormalities of the gastrointestinal tract, occurring in approximately 2% of the population. Nearly two centuries have passed since its first description by Johan Friederich Meckel. Meckel's diverticulum is a true intestinal diverticulum that results from the failure of the vitelline duct to obliterate during the fifth week of fetal development. 1 It contains all normal layers of the intestinal wall and, in approximately 50 percent of cases, contains tissue from other sites (ectopic tissue), 60-85% of which is gastric mucosa and 5-16% pancreatic tissue. 2 In the majority of cases, it is asymptomatic. However, it is prone to complications, especially in children, due to ectopic epithelial lining and various bands, reflective of its embryological development. Although the lifetime risk of a Meckel's diverticular complication varies from 4 to 34%, more than 50 to 60% of the patients who develop symptoms are younger than 2 years of age.3 Harper et al. suggested that a bleeding MD should be identifiable scintigraphically using 99mTc pertechnetate, since it is concentrated by gastric mucosa.4 The Tc99 Meckel's scan has a reported sensitivity of 81 to 90%.5 The purpose of this study was to review the various presentations of Meckel's diverticulum, to estimate the epidemiologic features and the extent of this clinical entity at our center and to review the detection techniques and treatment options.

Clinical Presentation and Imaging Findings in Patients With Pulsatile Tinnitus and Sigmoid Sinus Diverticulum/Dehiscence

Sigmoid sinus diverticulum/dehiscence (SSDD) is an increasingly recognized venous cause for pulsatile tinnitus (PT). SSDD is amenable to surgical/endovascular intervention. We aim to understand the clinical and imaging features of patients with PT due to SSDD. Retrospective CT study and chart review. Tertiary-care, academic center. Cohort 1: 200 consecutive unique temporal bone CT were blindly reviewed for anatomic findings associated with PT. Cohort 2: 61 patients with PT were evaluated for otologic manifestations. All patients underwent a temporal bone CT for evaluation of PT. Clinical information was gathered using electronic medical records. Otologic symptoms and physical findings (including body mass index (BMI), mastoid/neck bruits) were analyzed. Temporal bone CT scans were evaluated for the presence of SSDD and other possible causes of PT. Cohort 1: 35 cases of SSDD were identified (18%); 10 (29%) true diverticula; and 25 (71%) dehiscence. Sixty-six percent were right sided. Twelve patients had PT (34%). Patients with SSDD are more likely to have PT (p = 0.003). A significant association between right SSDD and PT was found (p = 0.001). Cohort 2: 15 out of 61 patients had PT and CT-confirmed SSDD. All were female subjects; average age was 45 years (26-73 yr). Radiologic evaluation revealed 10 SSDD cases on the right (66.7%), 2 on the left (13.3%%), and 3 bilateral (20%). Sensorineural hearing loss was seen in 8 (53%), aural fullness in 12 (80%). Average BMI was 32.2 (21.0-59.82), and 4 (26%) had audible mastoid bruits. SSDD may be the most common identifiable cause for PT from venous origin and is potentially treatable. Temporal bone CT scans should be included in a complete evaluation of PT.

Gedeckte Perforation eines Meckel-Divertikels – eine seltene sonografische Diagnose bei älteren Erwachsenen mit akutem Abdomen

Meckel’s diverticulum is the result of an incomplete obliteration of the vitelline duct, which joins the yolk sac to the midgut lumen and is typically obliterated during the sixth week of gestation. It’s considered the most common congenital anomaly of the gastrointestinal tract, affecting 2 % of the general population. It is a true diverticulum, located in the distal ileum and consisting of all layers of the bowel wall. The distance between the diverticulum and the ileocecal valve changes with increasing age, from an average distance of 34 cm in children (< 2 years) to an average distance of 67 cm in adults. Only 4 % of people with Meckel’s diverticulum develop complications (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006). Most complications occur in patients under the age of 2. Further predisposing factors are male sex (male: female = 3:1), diverticulum length of more than 2 cm and ectopic tissue in the diverticulum wall. Heterotopic gastric mucosa is present in 50 % of all Meckel’s diverticula, pancreatic mucosa is encountered in approximately 5 % of diverticula, and colonic mucosa is present on rare occasions (Chandramohan K et al. Gastrointestinal stromal tumour in Meckel’s diverticulum; World Journal of Surgical Oncology 2007, 5: 50). The most common clinical presentations of the Meckel’s diverticulum in adults are intestinal obstruction (22–50 %) and diverticulitis (20 %).Bleeding is less common. In children the most frequent complication is hemorrhage (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006).

Esophageal diverticula: Analysis of 25 cases.

esophageal diverticula are classified as 2 types: true diverticula and pseudodiverticula. These disorders result in clinical manifestations such as dysphagia and esophageal reflux. In this study, we evaluated the results of surgical treatment for diverticula. all patients suffering from symptomatic esophageal diverticulum, who underwent surgical treatment in Ghaem Hospital from 2000 to 2012 and were followed up for at least for one year, were included in the study. Age, sex, clinical manifestations, location, surgical approach, and mortality were evaluated. There were 25 patients (15 men and 10 women) with a mean age of 41 ± 8.3 years. the most common site of involvement was inferior (epiphrenic diverticulum). Barium swallow was diagnostic. After surgical treatment, complications occurred in 4 (16%) patients, comprising anastomosis site leakage, hoarseness, atelectasis, and wound infection; all were treated medically. There was no postoperative mortality. All patients experienced an improvement in symptoms during one year of follow-up. due to the good results and minimal complications postoperatively, surgical treatment is recommended for patients with symptomatic esophageal diverticulum.

Perforated gastrointestinal stromal tumor (GIST) in a true jejunal diverticulum in adulthood: report of a case

A 61-year-old man was referred to us for investigation of acute abdominal pain. Computed tomography showed a 5.9 × 5.3 × 5.0 cm lump of food residue in the jejunum, and a large amount of free air and ascites around the liver and right paracolic gutter. He underwent emergency laparotomy for suspected peritonitis from perforation by a foreign body in the small intestine. We identified purulent exudate in the abdominal cavity and perforation of a jejunal cystic mass, attached ~40 cm from Treitz's ligament at the anti-mesenteric side of the jejunum. Based on a diagnosis of jejunal duplication with perforation, we resected that part of the small intestine and performed intra-abdominal drainage. Pathological findings confirmed the diagnosis of a perforated gastrointestinal stromal tumor (GIST) in a true jejunal diverticulum. Histopathological evidence suggests that intestinal pressure and/or hemorrhage can cause perforation in the background of a true jejunal diverticulum. To our knowledge, this is the first case report of a perforated GIST in a true jejunal diverticulum.

English

Littre's Hernia is an abnormal protrusion of Meckel's Diverticulum through an abdominal opening. Alexis Littre first described the condition in relation to a femoral hernia in 1770 (1). It is a very rare condition and very few cases are reported till date. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. It is a true diverticulum found in the anti-mesentric border. It is the remnant of the persistent intestinal part of the vitello-intestinal or omphalo-enteric duct and comprises of all intestinal layers (2, 3, 4). It is found in 2% of total population, 2 feet from ileo-caecal junction and 2 inches in length, 2 types of common ectopic tissue (gastric and pancreatic). Meckel's diverticulum may be accompanied in the sac by the ileal loop to which it is attached; rarely, it may undergo incarceration or strangulation, necrosis, and perforation. In children, it is mostly found in umbilical hernias in which case it is more prone to adhere to the sac. Intestinal obstruction may occur due to volvulus, intussusception or very rarely as a complication of Littre's hernia (2, 3, 5). Its diagnosis is usually difficult despite the availability of modern investigative tools. A high index of suspicion is mandatory. In most cases it is an incidental finding. Hernial obstruction and strangulation of Meckel's diverticulum (Littre's Hernia) is a rare phenomenon and representing 10% of all complications of Meckel's diverticulum (6, 7). Surgery is the mainstay of treatment. We herein present an extremely rare case of strangulated Meckel's diverticulum in a Ventral Hernia (Littre's Hernia) which only became evident during surgery. The ventral hernia developed following emergency appendicectomy operation done for acute appendicitis 5 months back.

English

Perforation of a Meckel's diverticulum is a rare complication. This case report is about a 9yr old child who presented to our emergency department with diffuse abdominal pain, vomiting and fever. He had leucocytosis and free fluid in the peritoneal cavity on USG. Erect x-ray abdomen shows gas under the diaphragm. A perforated appendix or a bowel perforation was suspected and a diagnosis of a ruptured MD was finally made by laparotomy. INTRODUCTION: MD is a true intestinal diverticulum that results from the failure of the vitelline duct (omphalomesenteric duct) to obliterate during the 5 th week of fetal development 1 . MD is the most common congenital abnormality occurring in about 2% of the population. Meckel diverticulum is typically lined by ileal mucosa, but other tissue types are also found with varying frequency. The heterotopic mucosa is most commonly gastric (present in 50% of all MD's) and pancreatic mucosa is encountered in about 5% of diverticula; less commonly, these diverticula may harbour colonic mucosa 2 . This is important because peptic ulceration of this or adjacent mucosa can lead to painless bleeding, perforation, or both. CASE PRESENTATION: A 9 year old, previously healthy child, presented at the emergency room of Dept. of Surgery, AIMS, Bellur, with abdominal pain, that started in the left iliac fossa 24 hrs ago and progressed to be diffuse, accompanied with vomiting and high grade fever. Physical examination showed the patient to be pale and febrile (body temperature of 102 F) with diffuse tenderness along with rebound tenderness in the right iliac fossa. Guarding was noted in all the quadrants. Laboratory tests showed anemia (10.0g %) with leukocytosis (13000cells/cu mm) accompanied with polymorphonuclear predominance (89%) and normal blood biochemistry analysis. Erect X-ray abdomen showed gas under the diaphragm. USG abdomen revealed echogenic free fluid in the peritoneal cavity with few septations in the RIF-? Pyoperitoneum. These findings led to the diagnosis of a bowel perforation. A laparotomy incision made and pyoperitoneum confirmed. Appendix was inflamed and the bowel inspected. A perforated MD found and resection anastomosis of ileum along with appendectomy done. The patient recovered uneventfully and 7 days later was discharged in a fine condition. Histopathological examination showed Meckel's diverticulitis with ectopic gastric tissue forming an adenoma.

Meckel’s Diverticulum with Covered Perforation – A Rare Sonographic Diagnosis in Elderly Adults with Acute Abdomen

Meckel’s diverticulum is the result of an incomplete obliteration of the vitelline duct, which joins the yolk sac to the midgut lumen and is typically obliterated during the sixth week of gestation. It’s considered the most common congenital anomaly of the gastrointestinal tract, affecting 2 % of the general population. It is a true diverticulum, located in the distal ileum and consisting of all layers of the bowel wall. The distance between the diverticulum and the ileocecal valve changes with increasing age, from an average distance of 34 cm in children (< 2 years) to an average distance of 67 cm in adults. Only 4 % of people with Meckel’s diverticulum develop complications (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006). Most complications occur in patients under the age of 2. Further predisposing factors are male sex (male: female = 3:1), diverticulum length of more than 2 cm and ectopic tissue in the diverticulum wall. Heterotopic gastric mucosa is present in 50 % of all Meckel’s diverticula, pancreatic mucosa is encountered in approximately 5 % of diverticula, and colonic mucosa is present on rare occasions (Chandramohan K et al. Gastrointestinal stromal tumour in Meckel’s diverticulum; World Journal of Surgical Oncology 2007, 5: 50). The most common clinical presentations of the Meckel’s diverticulum in adults are intestinal obstruction (22–50 %) and diverticulitis (20 %).Bleeding is less common. In children the most frequent complication is hemorrhage (Dumper J et al. Complications of Meckel’s diverticula in adults; J Can chir, Vol. 49, No. 5; oct. 2006).

Colitis Ulcerosa together with Meckel's diverticulum causing severe haemorrhage in children

Meckel diverticulum is a vertigal remnant of the omphalomesenteric(vitellointestinal) duct.As a congenitaly anomaly it is a true diverticulum,ranger from 1 – 12 cm in a lenghtand it found 45 – 90 cm proximal to the ileocecal valve.It is frequently heterotopic tissue(gastric mucosa accounts for 50%),occurs in about 2% of the general population.The cause of bleeding is mucosal ulceration,because the ectopic gastric mucosa produces hydrocholic acid.The male or female ratio of patients with symptomatic diverticulum is 3:1.The association between bleeding Meckel's diverticulum and bleeding ulcerative colitis is unknown in a hungarian pediatric literature.We describe the case of a 9 years old boy presented nausea,intermittal abdominal pain and rectal bleeding.He has not been earlier any illness.Total colonoscopy was done with biopsy. We diagnosed ulcerative colitis,the histological examination showed the presence of inflammation colonic mucosa (crypta abscess,signs of severe colitis).He had been transmitted in the intensive care unit with recurrence rectal bleeding.He received transfusion because of severe anaemia. Abdominal reultrasound examination was negativ.99mTc pertechnetate didn't localized bleeding place in the abdominal tract.After 5 days the new rectal bleeding indicated explorative laparatomy suspected Meckel's diverticulum despite of negative scintigraphy.Meanwhile of laparatomy we diagnosed Meckel's. diverticulum(10 cm lenght,45 cm from the ileocecal valve).The histology found ectopic gastric mucosa int he diverticulum.The diverticulum resection,appendectomy were made.The ulcerative colitis has been treated with medicament.The control blood test is negativ.He was descharged after 10 days laparatomy.The correct value of signs and new signs is very importent indicating conservative treatment or surgical intervention.

Laparoscopy‐assisted Anorectal Pull‐through in Anorectal Malformations: A Reappraisal

Anorectal malformation is a complex anomaly with a broad variety of expressions. There are different techniques available for correction of the anomaly, all with their specific morbidity. Recently, much attention has been paid to acquired posterior urethral diverticulum after correction of anorectal malformation. The aim of this retrospective study was to reappraise the laparoscopic approach to correction of the anorectal malformation with respect to what can be prevented and what can be improved. Between July 2000 and July 2011, a total of 19 boys born with a high or intermediate anorectal malformation were admitted to our center. All patients underwent a diagnostic workup and were included in the follow-up protocol. Follow-up continence was scored according to the Krickenbeck criteria. Patients were also invited for an ultrasound and micturition cystourethrogram (MCUG) at follow-up to determine or exclude the presence of a posterior urethral diverticulum. All patients underwent a successful laparoscopy-assisted anorectal pull-through. Mean age at the time of surgery was 2.5 months. Mean length of hospital stay was 5 days. Mean follow-up was 73 months. Complications were encountered in six patients. At follow-up 53 % of all our patients had spontaneous bowel movements and 41 % needed the help of laxatives or rectal washouts. In three patients a residual blind ending fistula was determined on MCUG but there was no true diverticulum. Correction of anorectal malformation is a complex procedure with significant morbidity. Refinements of the technique may prevent complications and improve outcome in both the laparoscopic and posterior sagittal anorectoplasty. Acquired posterior urethral diverticulum does not necessarily need to occur more often with the laparoscopic approach.

Perforated solitary giant true jejunal diverticulum

Jejunal diverticula are rare and usually asymptomatic. However, they may cause chronic non-specific symptoms or rarely lead to an acute presentation. Here, we report a rare case of a child presenting with a perforated congenital jejunal diverticulum. We report a case of 10-year-old female who presented with severe acute abdominal pain, repeated vomiting, hypotension, and tachycardia of 1 day duration. Chest X-ray showed free air under diaphragm and abdominal X-ray displayed dilated bowel loops. Laboratory investigations showed leukocytosis and hyperamylasemia. After intravenous (IV) fluid resuscitation, diagnostic laparoscopy was performed that detected the presence of perforated solitary giant jejunal diverticulum, about 25 cm from the duodenojejunal junction, in addition to diffuse peritonitis. We had to convert to laparotomy due to the presence of huge amount of undigested food particles. Resection of the diverticulum-bearing segment and anastomosis was done along with thorough peritoneal decontamination and washout. Solitary giant jejunal diverticulum is a rare condition which can present with chronic vague abdominal pain and altered bowel habits, and can present acutely with complications as perforation with significant morbidity.