Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal trac...Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal tract,including the duodenum and jejunum,underscores the need for comprehensive understanding and management.In this minireview we analyzed the epidemiology,pathogenesis,clinical presentation,diagnosis,and management of DD with a specific focus on jejunal diverticulosis.Although the incidence of gastrointestinal DD increases with age,the male and female prevalence is the same.Clinical presentation is either asymptomatic or with unclear abdominal symptoms.However,complications such as perforation and bleeding can occur in a subset of patients and demand urgent diagnosis and surgical treatment.Imaging alternatives,including CT and enteroscopy,play key roles in diagnosis.Surgical management is warranted in cases with persistent bleeding or more complicated acute abdomen.Jejunal diverticulosis(JD)is a less common condition and poses a unique diagnostic and therapeutic challenge.Bleeding has been reported as the most important complication in JD.Therefore,early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality.This article highlighted the importance of considering JD in the differential diagnosis of gastrointestinal bleeding,especially in patients with concurrent colon diverticulosis in which the bleeding source remains unidentified.Therefore,current challenges in JD are better understanding the etiopathology and optimal management strategies.展开更多
BACKGROUND Jejunal diverticula(JD)are rare clinical conditions that are typically incidentally detected and asymptomatic.When acute complications arise,surgical exploration may be necessary for accurate diagnosis and ...BACKGROUND Jejunal diverticula(JD)are rare clinical conditions that are typically incidentally detected and asymptomatic.When acute complications arise,surgical exploration may be necessary for accurate diagnosis and appropriate treatment.In this report,we present a case of multiple JD complicated by gastrointestinal bleeding and review the pathogenesis,diagnosis,and treatment of JD to increase clinician awareness of this condition.CASE SUMMARY A 70-year-old male patient with multiple JD presented with repeated massive gastrointestinal bleeding.The patient did not respond to symptomatic conservative treatment.Additional diagnostic investigations,including digestive endoscopy and abdominal angiography,did not reveal any relevant abnormalities.An exploratory laparotomy was subsequently performed,during which a segment of the bowel containing numerous diverticulum-like structures was surgically removed.Following successful discharge from the hospital,the patient did not experience any further episodes of gastrointestinal bleeding during subsequent follow-up.CONCLUSION Complications caused by JD are often difficult to diagnose,and surgical exploration is sometimes the most appropriate method.展开更多
BACKGROUND Here,we report a case of jejunal diverticulosis from an anatomical and histological view.During the“Gross Anatomy course,”we found multiple jejunal diverticula along a total length of 208 cm of intestine....BACKGROUND Here,we report a case of jejunal diverticulosis from an anatomical and histological view.During the“Gross Anatomy course,”we found multiple jejunal diverticula along a total length of 208 cm of intestine.CASE SUMMARY After opening the intestinal tract,we counted 232 jejunal diverticulum entry points with a diameter of up to 2 cm and observed connections between the diverticula that created shortcuts between two distinct intestinal parts.Interestingly,we observed an extreme longitudinal striation on the intestinal parts hosting diverticula.Thorough vessel preparation utilizing a dissecting microscope confirmed that all investigated arteriae rectae ended in a diverticulum.Histological and immunohistochemical investigations revealed that intestinal villi of diverticula were smaller and less prominent than control tissue and that the stratum longitudinale,as well as the stratum circular,were much thinner in the diverticula compared to control tissue.Neither submucosal nor mesenteric plexus could be detected in the diverticula.However,vasoactive intestinal peptidepositive nerve fibers and villin-positive brush border could only be detected in control tissue.This indicates that jejunal diverticulosis is associated with abnormalities of the smooth muscles and a disorder of innervation.CONCLUSION Jejunal diverticulosis originates from mesenteric vessels,featuring smooth muscle changes,absent innervation,and thinning of tissue layers.展开更多
Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and femal...Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.展开更多
Background: Calyceal diverticulae and megacalycosis are rare congenital anomalies. The majorities are asymptomatic but they can present with complications. Objective: The objective of this study is to describe the cli...Background: Calyceal diverticulae and megacalycosis are rare congenital anomalies. The majorities are asymptomatic but they can present with complications. Objective: The objective of this study is to describe the clinical presentations, complications, urographic diagnosis of calyceal diverticulae, megacalycosis, and their treatment. Methods: A descriptive study carried out over 8 years period from March 2012 to December 2019. In three big hospital of Aden province, we collect 15 patients aged from seven to 41 years (mean 13.5 years), our patients were 9 female (60%) and 6 male (40%). They diagnosed incidentally with calyceal diverticulae and megacalycosis by contrasted urography, describing the clinical manifestations, localization, complications, and type of treatment. Results: Sixty percent of patients with calyceal diverticulae and megacalycosis were women and (40%) were men. Clinical manifestations including, dull aching flank and abdominal pain in (40%), acute renal colic (20%), recurrent urinary tract infection (33%), and abdominal pain with a fever of unknown origin in (7%). Calyceal diverticula and megacalycosis were bilateral in (53%) and unilateral in (47%). In the right kidney were (57%), and in the left kidney (43%). In the upper pole of the kidney were (53.3%), middle pole (33.3%), and lower pole (13.3%). Complications occurred in (47%) of patients. They including, urinary stones in (71.4%), hypertension (14.3%), and delayed renal excretion (14.3%). Conservative treatment carried out in (73%) and surgically intervened in (27%). Conclusions: Calyceal diverticula and megacalycosis are rare anomalies. Dull aching flank pain and recurrent urinary tract infections are the most frequent clinical presentations. The most common complications are urinary stones. Conservative treatment is a common type of treatment.展开更多
AIM:To evaluate the safety and effectiveness of endoscopic papillary large balloon dilation(EPLBD)for bile duct stone extraction in patients with periampullary diverticula.METHODS:The records of 223 patients with larg...AIM:To evaluate the safety and effectiveness of endoscopic papillary large balloon dilation(EPLBD)for bile duct stone extraction in patients with periampullary diverticula.METHODS:The records of 223 patients with large common bile duct stones(≥10 mm)who underwent EPLBD(12-20 mm balloon diameter)with or without limited endoscopic sphincterotomy(ES)from July 2006to April 2011 were retrospectively reviewed.Of these patients,93(41.7%)had periampullary diverticula(PAD),which was categorized into three types.The clinical variables of EPLBD with limited ES(EPLBD+ES)and EPLBD alone were analyzed according to the presence of PAD.RESULTS:Patients with PAD were significantly older than those without(75.2±8.8 years vs 69.7±10.9years,P=0.000).The rates of overall stone removal and complete stone removal in the first session were not significantly different between the PAD and nonPAD groups,however,there was significantly less need for mechanical lithotripsy in the PAD group(3.2%vs 11.5%,P=0.026).Overall stone removal rates,complete stone removal rates in the first session and the use of mechanical lithotripsy were not significantly different between EPLBD+ES and EPLBD alone in patients with PAD(96.6%vs 97.1%;72.9%vs 88.2%;and 5.1%vs 0%,respectively).No significant differences with respect to the rates of pancreatitis,perforation,and bleeding were observed between EPLBD+ES and EPLBD alone in the PAD group(3.4%vs 14.7%,P=0.095;0%vs 0%;and 3.4%vs 8.8%,P=0.351,respectively).CONCLUSION:EPLBD with limited ES and EPLBD alone are safe and effective modalities for common bile duct stone removal in patients with PAD,regardless of PAD subtypes.展开更多
AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS:...AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated. RESULTS: There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047). CONCLUSION: Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.展开更多
The widespread popularity of new surgical technologies such as laparoscopy, thoracoscopy and robotics has led many surgeons to treat esophageal diseases with these methods. The expected benefits of minimally invasives...The widespread popularity of new surgical technologies such as laparoscopy, thoracoscopy and robotics has led many surgeons to treat esophageal diseases with these methods. The expected benefits of minimally invasivesurgery(MIS) mainly include reductions of postoperative complications, length of hospital stay, and pain and better cosmetic results. All of these benefits could potentially be of great interest when dealing with the esophagus due to the potentially severe complications that can occur after conventional surgery. Moreover, robotic platforms are expected to reduce many of the difficulties encountered during advanced laparoscopic and thoracoscopic procedures such as anastomotic reconstructions, accurate lymphadenectomies, and vascular sutures. Almost all esophageal diseases are approachable in a minimally invasive way, including diverticula, gastro-esophageal reflux disease, achalasia, perforations and cancer. Nevertheless, while the limits of MIS for benign esophageal diseases are mainly technical issues and costs, oncologic outcomes remain the cornerstone of any procedure to cure malignancies, for which the long-term results are critical. Furthermore, many of the minimally invasive esophageal operations should be compared to pharmacologic interventions and advanced pure endoscopic procedures; such a comparison requires a difficult literature analysis and leads to some confounding results of clinical trials. This review aims to examine the evidence for the use of MIS in both malignancies and more common benign disease of the esophagus, with a particular emphasis on future developments and ongoing areas of research.展开更多
BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To d...BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large(>1.2 cm)CBD stones.After occlusion cholangiography confirmed CBD stone clearance,peroral cholangioscopy(POC)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via POC were graded on a 5-point scale(score 1,worst;score 5,best).Scores were documented after only stone removal(control)and after irrigation with 50 mL and 100 mL saline,respectively.The stone composition was analyzed using infrared spectroscopy.RESULTS Between October 2018 and January 2020,47 patients had CBD clearance scores of 2.4±1.1 without saline irrigation,3.5±0.7 with 50 mL irrigation,and 4.6±0.6 with 100 mL irrigation(P<0.001).Multivariate analysis showed that CBD diameter>15 mm[odds ratio(OR)=0.08,95%confidence interval(CI):0.01-0.49;P=0.007]and periampullary diverticula(PAD)(OR=6.51,95%CI:1.08-39.21;P=0.041)were independent risk factors for residual stones.Bilirubin pigment stones constituted the main residual stones found in patients with PAD(P=0.004).CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy,especially in patients with PAD and/or a dilated(>15 mm)CBD.Pigment residual stones are soft and commonly found in patients with PAD.Additional saline irrigation may be required to remove retained stones.展开更多
AIM： To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population. METHODS： One hundred and forty patients, treated for symptomatic diver...AIM： To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population. METHODS： One hundred and forty patients, treated for symptomatic diverticular disease in a community based hospital, were included. Thirty （21%） had signs of diverticular bleeding. Age, gender, and the results of colonoscopy were collected and compared to a group of patients with nonbleeding symptomatic diverticulosis. Records were reviewed for comorbidities, such as obesity, alcohol consumption, smoking habits and metabolic diseases. Special emphasis was put on arterial hypertension, cardiovascular events, diabetes mellitus, hyperuricemia and hypercholesterinemia. RESULTS： There was no difference between patients with diverticular hemorrhage and those with nonbleeding symptomatic diverticulosis regarding gender ratio （male/female 9/21 vs 47/63） and diverticular Iocalisation. Bleeding patients differed in respect to age （73.4± 9.9 vs 67. 8± 13.0, P 〈 0.013）. Significant differences were found between both groups regarding the presence of hyperuricemia and use of steroids and nonsteroidal anti-inflammatory drugs. Patients with three concomitant metabolic diseases were also identified as being at risk of bleeding. A forward stepwise logistic regression analysis revealed steroids, hyperuricemia and the use of calcium-channel blockers as independent risk factors of bleeding.CONCLUSION： Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding.展开更多
AIM:To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip(OTSC)placement.METHODS:We retrospectively enrolled 20 patients(13 female and 7 male;mean ...AIM:To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip(OTSC)placement.METHODS:We retrospectively enrolled 20 patients(13 female and 7 male;mean age:70.6±9.8 years)in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement.Gastrointestinal tract perforation could be with oval-shape or with round-shape.Ovalshape perforations were closed by OTSC only by suction and the round-shape by the"twin-grasper"plus suction.RESULTS:Main perforation diameter was 10.1±4.3 mm(range 3-18 mm).The technical success rate was 100%(20/20 patients)and the clinical success rate was 90%(18/20 patients).Two patients(10%)who did not have complete sealing of the defect underwent surgery.Based upon our observations we propose two types of perforation:Round-shape"type-1 perforation"and oval-shape"type-2 perforation".Eight(40%)out of the 20 patients had a type-1 perforation and 12 patients a type-2(60%).CONCLUSION:OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy.A failed closure attempt does not impair subsequent surgical treatment.展开更多
Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists ...Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists of surgical resection. We describe a case of perforated jejunoileal diverticulum with localized abscess and highlight the merits of surgical vs medical management. The patient is a 77-year-old male who presented with sharp, constant abdominal pain just inferior to the umbilicus. Administration of intravenous antibiotics results in complete and long-term resolution of the patient’s symptoms. In this report, we establish a framework for safely treating perforated small bowel diverticulum without surgical exploration.展开更多
Jejunal diverticula are quite rare.Furthermore,small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention.In this manuscript,we report two presentations of ...Jejunal diverticula are quite rare.Furthermore,small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention.In this manuscript,we report two presentations of jejunal diverticulum with complications from enteroliths followed by a review of the literature.The first case was that of a 79-year-old male who presented with abdominal pain and was found,on computed tomography scan,to have evidence of intestinal perforation.A laparotomy showed that he had perforated jejunal diverticulitis.The second case was that of an 89-year-old female who presented with recurrent episodes of bowel obstruction.A laparotomy showed that she had an enterolith impacted in her jejunum in the presence of significant diverticular disease.Although a rare entity,familiarity with jejunal diverticular disease,its complications,and its management,should be part of every surgeon's base of knowledge when considering abdominal pathology.展开更多
Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently ...Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.展开更多
The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of...The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.展开更多
The occurrence of rectal diverticula is very rare, with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are encountered even less frequently.Treatments of these complicated events ra...The occurrence of rectal diverticula is very rare, with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are encountered even less frequently.Treatments of these complicated events range from conservative treatments to major surgical interventions.We present a hitherto unreported occurrence of isolated rectal diverticulum complicated with rectal prolapse and outlet obstruction. Delorme's procedure resulted in subsidence of symptoms and resolution of the diverticulum. It provides a minimal invasive surgical technique to successfully address the reported malady.展开更多
Objective: To determine the causes of choledochal di-latation in patients with obstructive jaundice.Methods: One hundred and sixty-four patients withobstructive jaundice were investigated by endoscopicretrograde chola...Objective: To determine the causes of choledochal di-latation in patients with obstructive jaundice.Methods: One hundred and sixty-four patients withobstructive jaundice were investigated by endoscopicretrograde cholangiopancreatography(ERCP), and pa-tients with choledochal dilatation (group Ⅰ, n=110)were compared with those without choledochal dilata-tion(group Ⅱ, n=54).Results: The causes of common bile duct dilatationwere choledocholith, juxtapapillary duodenal divertic-ula and congenital dilatation of the common bile duct.The distal common bile duct and its surroundings wereabnormal in 104(94.55%) of the 110 patients and in 13(24.08%) of the 54 patients (P【0.01). Juxtapapil-lary duodenal diverticulum accounted for 24.55% ingroup Ⅰ, and only in 9.26% in group Ⅱ (P【0.05).Post-cholecystectomy patients were 13.64% in groupⅠ, and only 5.56% in group Ⅱ.Conclusions: The abnormalities of the distal commonbile duct and its surroundings can usually be detectedas underlying causes of common bile duct dilatation.ERCP is necessary before cholecystectomy, since it isconsidered the "gold standard" for the diagnosis ofdistal common bile duct abnormalities.展开更多
Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin- testinal symptoms. Most of times the diagnosis is carried out in ca...Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin- testinal symptoms. Most of times the diagnosis is carried out in case of related complications, such as diverticulitis, hemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or jejunal stones. Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.展开更多
Purpose: The clinical significance of newly identified left atrial anatomic abnormalities (LAAA)— accessory appendages, diverticula, septal pouches—by multidetector CT (MDCT) remains unclear. Similar anatomical outp...Purpose: The clinical significance of newly identified left atrial anatomic abnormalities (LAAA)— accessory appendages, diverticula, septal pouches—by multidetector CT (MDCT) remains unclear. Similar anatomical outpouchings, i.e., the left atrial appendage, have been associated with cardioembolisms and arrhythmia. To test the hypothesis that LAAA are also associated with increased risk of these events, we performed a retrospective analysis to examine the association of LAAA in patients undergoing CT with embolic events and arrhythmia. Methods: 242 patients (mean age 56 SD 12 years, 41% female) were selected who had CT coronary angiography performed with 64-row MDCT between 2007 and 2012 if complete clinical history records were available. CT images were independently reviewed for the presence of LAAA. Association of cerebrovascular accident (CVA) or transient ischemic attack (TIA), atrial fibrillation, and palpitations to LAAA was calculated using odds ratios (OR) with 95% confidence interval (CI) and Fisher’s exact test. Results: After adjusting for age, sex, hypertension, dyslipidemia and diabetes via multiple logistic regression, patients with accessory appendages are more likely to have reported palpitations (OR: 1.80;CI: 1.03 - 3.16). Patients with diverticula and septal pouches are significantly older than those without these abnormalities (p = 0.01 and p = 0.02, respectively). Septal pouches are associated with diabetes (OR: 2.29;95%CI: 1.15 - 4.54). Conclusions: Accessory left atrial appendages are associated with palpitations. Patients with septal pouches and diverticula are significantly older than those patients without these anatomic abnormalities, suggesting age dependency of these findings. None of these anatomic abnormalities were associated with thromboembolic events after adjustment for potentially confounding comorbidities.展开更多
Celiac disease can be triggered by upper abdominal surgery, such as vagotomy, oesophagectomy, pancreatico-duodenectomy, and gastrojejunal anastomosis. Here we report a case of a 24 year-old woman who developed celiac ...Celiac disease can be triggered by upper abdominal surgery, such as vagotomy, oesophagectomy, pancreatico-duodenectomy, and gastrojejunal anastomosis. Here we report a case of a 24 year-old woman who developed celiac disease after an ileal resection for perforated Meckel's diverticula. This is the first reported celiac case that has been triggered, not by upper abdominal surgery, but after ileal resection for Meckel's diverticula.展开更多
文摘Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal tract,including the duodenum and jejunum,underscores the need for comprehensive understanding and management.In this minireview we analyzed the epidemiology,pathogenesis,clinical presentation,diagnosis,and management of DD with a specific focus on jejunal diverticulosis.Although the incidence of gastrointestinal DD increases with age,the male and female prevalence is the same.Clinical presentation is either asymptomatic or with unclear abdominal symptoms.However,complications such as perforation and bleeding can occur in a subset of patients and demand urgent diagnosis and surgical treatment.Imaging alternatives,including CT and enteroscopy,play key roles in diagnosis.Surgical management is warranted in cases with persistent bleeding or more complicated acute abdomen.Jejunal diverticulosis(JD)is a less common condition and poses a unique diagnostic and therapeutic challenge.Bleeding has been reported as the most important complication in JD.Therefore,early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality.This article highlighted the importance of considering JD in the differential diagnosis of gastrointestinal bleeding,especially in patients with concurrent colon diverticulosis in which the bleeding source remains unidentified.Therefore,current challenges in JD are better understanding the etiopathology and optimal management strategies.
文摘BACKGROUND Jejunal diverticula(JD)are rare clinical conditions that are typically incidentally detected and asymptomatic.When acute complications arise,surgical exploration may be necessary for accurate diagnosis and appropriate treatment.In this report,we present a case of multiple JD complicated by gastrointestinal bleeding and review the pathogenesis,diagnosis,and treatment of JD to increase clinician awareness of this condition.CASE SUMMARY A 70-year-old male patient with multiple JD presented with repeated massive gastrointestinal bleeding.The patient did not respond to symptomatic conservative treatment.Additional diagnostic investigations,including digestive endoscopy and abdominal angiography,did not reveal any relevant abnormalities.An exploratory laparotomy was subsequently performed,during which a segment of the bowel containing numerous diverticulum-like structures was surgically removed.Following successful discharge from the hospital,the patient did not experience any further episodes of gastrointestinal bleeding during subsequent follow-up.CONCLUSION Complications caused by JD are often difficult to diagnose,and surgical exploration is sometimes the most appropriate method.
基金Supported by University Hospital of Giessen and Marburg(UKGM)-Justus-Liebig-University(JLU)-Cooperation Grant,No.7/2016 GIthe Else Kröner-Fresenius-Stiftung,No.2016_A90and the German Research Foundation,No.544054869.
文摘BACKGROUND Here,we report a case of jejunal diverticulosis from an anatomical and histological view.During the“Gross Anatomy course,”we found multiple jejunal diverticula along a total length of 208 cm of intestine.CASE SUMMARY After opening the intestinal tract,we counted 232 jejunal diverticulum entry points with a diameter of up to 2 cm and observed connections between the diverticula that created shortcuts between two distinct intestinal parts.Interestingly,we observed an extreme longitudinal striation on the intestinal parts hosting diverticula.Thorough vessel preparation utilizing a dissecting microscope confirmed that all investigated arteriae rectae ended in a diverticulum.Histological and immunohistochemical investigations revealed that intestinal villi of diverticula were smaller and less prominent than control tissue and that the stratum longitudinale,as well as the stratum circular,were much thinner in the diverticula compared to control tissue.Neither submucosal nor mesenteric plexus could be detected in the diverticula.However,vasoactive intestinal peptidepositive nerve fibers and villin-positive brush border could only be detected in control tissue.This indicates that jejunal diverticulosis is associated with abnormalities of the smooth muscles and a disorder of innervation.CONCLUSION Jejunal diverticulosis originates from mesenteric vessels,featuring smooth muscle changes,absent innervation,and thinning of tissue layers.
文摘Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.
文摘Background: Calyceal diverticulae and megacalycosis are rare congenital anomalies. The majorities are asymptomatic but they can present with complications. Objective: The objective of this study is to describe the clinical presentations, complications, urographic diagnosis of calyceal diverticulae, megacalycosis, and their treatment. Methods: A descriptive study carried out over 8 years period from March 2012 to December 2019. In three big hospital of Aden province, we collect 15 patients aged from seven to 41 years (mean 13.5 years), our patients were 9 female (60%) and 6 male (40%). They diagnosed incidentally with calyceal diverticulae and megacalycosis by contrasted urography, describing the clinical manifestations, localization, complications, and type of treatment. Results: Sixty percent of patients with calyceal diverticulae and megacalycosis were women and (40%) were men. Clinical manifestations including, dull aching flank and abdominal pain in (40%), acute renal colic (20%), recurrent urinary tract infection (33%), and abdominal pain with a fever of unknown origin in (7%). Calyceal diverticula and megacalycosis were bilateral in (53%) and unilateral in (47%). In the right kidney were (57%), and in the left kidney (43%). In the upper pole of the kidney were (53.3%), middle pole (33.3%), and lower pole (13.3%). Complications occurred in (47%) of patients. They including, urinary stones in (71.4%), hypertension (14.3%), and delayed renal excretion (14.3%). Conservative treatment carried out in (73%) and surgically intervened in (27%). Conclusions: Calyceal diverticula and megacalycosis are rare anomalies. Dull aching flank pain and recurrent urinary tract infections are the most frequent clinical presentations. The most common complications are urinary stones. Conservative treatment is a common type of treatment.
基金Supported by A Yeungnam University Research Grant in 2012
文摘AIM:To evaluate the safety and effectiveness of endoscopic papillary large balloon dilation(EPLBD)for bile duct stone extraction in patients with periampullary diverticula.METHODS:The records of 223 patients with large common bile duct stones(≥10 mm)who underwent EPLBD(12-20 mm balloon diameter)with or without limited endoscopic sphincterotomy(ES)from July 2006to April 2011 were retrospectively reviewed.Of these patients,93(41.7%)had periampullary diverticula(PAD),which was categorized into three types.The clinical variables of EPLBD with limited ES(EPLBD+ES)and EPLBD alone were analyzed according to the presence of PAD.RESULTS:Patients with PAD were significantly older than those without(75.2±8.8 years vs 69.7±10.9years,P=0.000).The rates of overall stone removal and complete stone removal in the first session were not significantly different between the PAD and nonPAD groups,however,there was significantly less need for mechanical lithotripsy in the PAD group(3.2%vs 11.5%,P=0.026).Overall stone removal rates,complete stone removal rates in the first session and the use of mechanical lithotripsy were not significantly different between EPLBD+ES and EPLBD alone in patients with PAD(96.6%vs 97.1%;72.9%vs 88.2%;and 5.1%vs 0%,respectively).No significant differences with respect to the rates of pancreatitis,perforation,and bleeding were observed between EPLBD+ES and EPLBD alone in the PAD group(3.4%vs 14.7%,P=0.095;0%vs 0%;and 3.4%vs 8.8%,P=0.351,respectively).CONCLUSION:EPLBD with limited ES and EPLBD alone are safe and effective modalities for common bile duct stone removal in patients with PAD,regardless of PAD subtypes.
基金Supported by A Grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare and Family Affairs,Republic of Korea (A091047)
文摘AIM: To investigate the effectiveness and safety of limited endoscopic sphincterotomy (EST) plus large balloon dilation (LBD) for removing choledocholithiasis in patients with periampullary diverticula (PAD). METHODS: A total of 139 patients with common bile duct (CBD) stones were treated with LBD (10-20 mm balloon diameter) after limited EST. Of this total, 73 patients had PAD and 66 patients did not have PAD (controls). The results of stone removal and complications were retrospectively evaluated. RESULTS: There were no significant differences between the PAD and the control groups in overall successful stone removal (94.5% vs 93.9%), stone removal in first session (69.9% vs 81.8%), mechanical lithotripsy (12.3% vs 13.6%), and complications (11.0% vs 7.6%). Clinical outcomes were also similar between the types of PAD, but the rate of stone removal in first session and the number of sessions were significantly lower and more frequent, respectively, in type B PAD (papilla located near the diverticulum) than controls [23/38 (60.5%) vs 54/66 (81.8%), P = 0.021; and 1 (1-2) vs 1 (1-3), P = 0.037, respectively] and the frequency of pancreatitis was significantly higher in type A PAD (papilla located inside or in the margin of the diverticulum) than in controls (16.1% vs 3.0%, P = 0.047). CONCLUSION: Limited EST plus LBD was an effective and safe procedure for removing choledocholithiasis in patients with PAD. However, some types of PAD should be managed with caution.
文摘The widespread popularity of new surgical technologies such as laparoscopy, thoracoscopy and robotics has led many surgeons to treat esophageal diseases with these methods. The expected benefits of minimally invasivesurgery(MIS) mainly include reductions of postoperative complications, length of hospital stay, and pain and better cosmetic results. All of these benefits could potentially be of great interest when dealing with the esophagus due to the potentially severe complications that can occur after conventional surgery. Moreover, robotic platforms are expected to reduce many of the difficulties encountered during advanced laparoscopic and thoracoscopic procedures such as anastomotic reconstructions, accurate lymphadenectomies, and vascular sutures. Almost all esophageal diseases are approachable in a minimally invasive way, including diverticula, gastro-esophageal reflux disease, achalasia, perforations and cancer. Nevertheless, while the limits of MIS for benign esophageal diseases are mainly technical issues and costs, oncologic outcomes remain the cornerstone of any procedure to cure malignancies, for which the long-term results are critical. Furthermore, many of the minimally invasive esophageal operations should be compared to pharmacologic interventions and advanced pure endoscopic procedures; such a comparison requires a difficult literature analysis and leads to some confounding results of clinical trials. This review aims to examine the evidence for the use of MIS in both malignancies and more common benign disease of the esophagus, with a particular emphasis on future developments and ongoing areas of research.
基金Supported by National Natural Science Foundation of China,No.81872036 and No.82060551.
文摘BACKGROUND A previous study showed that irrigation with 100 mL saline reduced residual common bile duct(CBD)stones,which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIM To determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODS This prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large(>1.2 cm)CBD stones.After occlusion cholangiography confirmed CBD stone clearance,peroral cholangioscopy(POC)was performed to determine clearance scores based on the number of residual stones.The amounts of residual stones spotted via POC were graded on a 5-point scale(score 1,worst;score 5,best).Scores were documented after only stone removal(control)and after irrigation with 50 mL and 100 mL saline,respectively.The stone composition was analyzed using infrared spectroscopy.RESULTS Between October 2018 and January 2020,47 patients had CBD clearance scores of 2.4±1.1 without saline irrigation,3.5±0.7 with 50 mL irrigation,and 4.6±0.6 with 100 mL irrigation(P<0.001).Multivariate analysis showed that CBD diameter>15 mm[odds ratio(OR)=0.08,95%confidence interval(CI):0.01-0.49;P=0.007]and periampullary diverticula(PAD)(OR=6.51,95%CI:1.08-39.21;P=0.041)were independent risk factors for residual stones.Bilirubin pigment stones constituted the main residual stones found in patients with PAD(P=0.004).CONCLUSION Irrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy,especially in patients with PAD and/or a dilated(>15 mm)CBD.Pigment residual stones are soft and commonly found in patients with PAD.Additional saline irrigation may be required to remove retained stones.
文摘AIM： To evaluate the risk factors-other than nonsteroidal anti-inflammatory drugs-for colonic diverticular bleeding in a westernized population. METHODS： One hundred and forty patients, treated for symptomatic diverticular disease in a community based hospital, were included. Thirty （21%） had signs of diverticular bleeding. Age, gender, and the results of colonoscopy were collected and compared to a group of patients with nonbleeding symptomatic diverticulosis. Records were reviewed for comorbidities, such as obesity, alcohol consumption, smoking habits and metabolic diseases. Special emphasis was put on arterial hypertension, cardiovascular events, diabetes mellitus, hyperuricemia and hypercholesterinemia. RESULTS： There was no difference between patients with diverticular hemorrhage and those with nonbleeding symptomatic diverticulosis regarding gender ratio （male/female 9/21 vs 47/63） and diverticular Iocalisation. Bleeding patients differed in respect to age （73.4± 9.9 vs 67. 8± 13.0, P 〈 0.013）. Significant differences were found between both groups regarding the presence of hyperuricemia and use of steroids and nonsteroidal anti-inflammatory drugs. Patients with three concomitant metabolic diseases were also identified as being at risk of bleeding. A forward stepwise logistic regression analysis revealed steroids, hyperuricemia and the use of calcium-channel blockers as independent risk factors of bleeding.CONCLUSION： Beside nonsteroidal anti-inflammatory steroid drug use, antihypertensive medication and concomitant arteriosclerotic diseases are risk factors for colonic diverticular hemorrhage. Our results support the hypothesis of an altered arteriosclerotic vessel as the source of bleeding.
文摘AIM:To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip(OTSC)placement.METHODS:We retrospectively enrolled 20 patients(13 female and 7 male;mean age:70.6±9.8 years)in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement.Gastrointestinal tract perforation could be with oval-shape or with round-shape.Ovalshape perforations were closed by OTSC only by suction and the round-shape by the"twin-grasper"plus suction.RESULTS:Main perforation diameter was 10.1±4.3 mm(range 3-18 mm).The technical success rate was 100%(20/20 patients)and the clinical success rate was 90%(18/20 patients).Two patients(10%)who did not have complete sealing of the defect underwent surgery.Based upon our observations we propose two types of perforation:Round-shape"type-1 perforation"and oval-shape"type-2 perforation".Eight(40%)out of the 20 patients had a type-1 perforation and 12 patients a type-2(60%).CONCLUSION:OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy.A failed closure attempt does not impair subsequent surgical treatment.
文摘Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists of surgical resection. We describe a case of perforated jejunoileal diverticulum with localized abscess and highlight the merits of surgical vs medical management. The patient is a 77-year-old male who presented with sharp, constant abdominal pain just inferior to the umbilicus. Administration of intravenous antibiotics results in complete and long-term resolution of the patient’s symptoms. In this report, we establish a framework for safely treating perforated small bowel diverticulum without surgical exploration.
文摘Jejunal diverticula are quite rare.Furthermore,small bowel diverticular disease resulting in enteroliths can lead to complications necessitating surgical intervention.In this manuscript,we report two presentations of jejunal diverticulum with complications from enteroliths followed by a review of the literature.The first case was that of a 79-year-old male who presented with abdominal pain and was found,on computed tomography scan,to have evidence of intestinal perforation.A laparotomy showed that he had perforated jejunal diverticulitis.The second case was that of an 89-year-old female who presented with recurrent episodes of bowel obstruction.A laparotomy showed that she had an enterolith impacted in her jejunum in the presence of significant diverticular disease.Although a rare entity,familiarity with jejunal diverticular disease,its complications,and its management,should be part of every surgeon's base of knowledge when considering abdominal pathology.
文摘Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.
文摘The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.
文摘The occurrence of rectal diverticula is very rare, with only sporadic reports in the literature since 1911. Symptomatic rectal diverticula are encountered even less frequently.Treatments of these complicated events range from conservative treatments to major surgical interventions.We present a hitherto unreported occurrence of isolated rectal diverticulum complicated with rectal prolapse and outlet obstruction. Delorme's procedure resulted in subsidence of symptoms and resolution of the diverticulum. It provides a minimal invasive surgical technique to successfully address the reported malady.
文摘Objective: To determine the causes of choledochal di-latation in patients with obstructive jaundice.Methods: One hundred and sixty-four patients withobstructive jaundice were investigated by endoscopicretrograde cholangiopancreatography(ERCP), and pa-tients with choledochal dilatation (group Ⅰ, n=110)were compared with those without choledochal dilata-tion(group Ⅱ, n=54).Results: The causes of common bile duct dilatationwere choledocholith, juxtapapillary duodenal divertic-ula and congenital dilatation of the common bile duct.The distal common bile duct and its surroundings wereabnormal in 104(94.55%) of the 110 patients and in 13(24.08%) of the 54 patients (P【0.01). Juxtapapil-lary duodenal diverticulum accounted for 24.55% ingroup Ⅰ, and only in 9.26% in group Ⅱ (P【0.05).Post-cholecystectomy patients were 13.64% in groupⅠ, and only 5.56% in group Ⅱ.Conclusions: The abnormalities of the distal commonbile duct and its surroundings can usually be detectedas underlying causes of common bile duct dilatation.ERCP is necessary before cholecystectomy, since it isconsidered the "gold standard" for the diagnosis ofdistal common bile duct abnormalities.
文摘Small bowel diverticulosis represents an uncommon disorder (except for Meckel diverticulum) often misdiagnosed since it causes non-specific gastroin- testinal symptoms. Most of times the diagnosis is carried out in case of related complications, such as diverticulitis, hemorrhage, perforation or obstruction. Intestinal obstruction can be caused by inflammatory stenosis due to repeated episodes of diverticulitis, volvulus, intussusception or jejunal stones. Herein we report a case of multiple jejunal diverticula causing chronic gastrointestinal obstruction.
文摘Purpose: The clinical significance of newly identified left atrial anatomic abnormalities (LAAA)— accessory appendages, diverticula, septal pouches—by multidetector CT (MDCT) remains unclear. Similar anatomical outpouchings, i.e., the left atrial appendage, have been associated with cardioembolisms and arrhythmia. To test the hypothesis that LAAA are also associated with increased risk of these events, we performed a retrospective analysis to examine the association of LAAA in patients undergoing CT with embolic events and arrhythmia. Methods: 242 patients (mean age 56 SD 12 years, 41% female) were selected who had CT coronary angiography performed with 64-row MDCT between 2007 and 2012 if complete clinical history records were available. CT images were independently reviewed for the presence of LAAA. Association of cerebrovascular accident (CVA) or transient ischemic attack (TIA), atrial fibrillation, and palpitations to LAAA was calculated using odds ratios (OR) with 95% confidence interval (CI) and Fisher’s exact test. Results: After adjusting for age, sex, hypertension, dyslipidemia and diabetes via multiple logistic regression, patients with accessory appendages are more likely to have reported palpitations (OR: 1.80;CI: 1.03 - 3.16). Patients with diverticula and septal pouches are significantly older than those without these abnormalities (p = 0.01 and p = 0.02, respectively). Septal pouches are associated with diabetes (OR: 2.29;95%CI: 1.15 - 4.54). Conclusions: Accessory left atrial appendages are associated with palpitations. Patients with septal pouches and diverticula are significantly older than those patients without these anatomic abnormalities, suggesting age dependency of these findings. None of these anatomic abnormalities were associated with thromboembolic events after adjustment for potentially confounding comorbidities.
文摘Celiac disease can be triggered by upper abdominal surgery, such as vagotomy, oesophagectomy, pancreatico-duodenectomy, and gastrojejunal anastomosis. Here we report a case of a 24 year-old woman who developed celiac disease after an ileal resection for perforated Meckel's diverticula. This is the first reported celiac case that has been triggered, not by upper abdominal surgery, but after ileal resection for Meckel's diverticula.
