Esophageal diverticulum can be broadly classified into three main types:Phar-yngoesophageal diverticulum located near the upper esophageal sphincter(including Zenker’s diverticulum,Killian-Jamieson diverticulum,and L...Esophageal diverticulum can be broadly classified into three main types:Phar-yngoesophageal diverticulum located near the upper esophageal sphincter(including Zenker’s diverticulum,Killian-Jamieson diverticulum,and Laimer’s diverticulum);Mid-esophageal diverticulum,and epiphrenic diverticulum loca-ted just above the lower esophageal sphincter.Most asymptomatic esophageal diverticulum are incidentally detected during routine imaging studies,such as barium swallow,computed tomography scans,or esophagogastroduodenoscopy.For these patients,regular follow-up is typically sufficient.However,a small subset may experience persistent symptoms such as dysphagia and acid reflux.Patients with symptomatic diverticulum should be assessed for the potential need for surgical intervention to prevent serious complications,including aspiration pneumonia and malnutrition.The treatment options for symptomatic esophageal diverticulum encompass both endoscopic and surgical approaches.Due to the technical complexity and significant risks associated with surgical intervention,endoscopic treatment has gained increasing preference,achieving remarkable results with the advancements in endoscopic instruments and techniques.Given the anatomical location and pathophysiological differences among esophageal diverticulum,a personalized endoscopic strategy is essential to achieve optimal results.This review provides an overview of the characteristics of esophageal diverticulum and offers a comprehensive discussion of diverticular peroral endoscopic myotomy and its related variations as the primary endoscopic treat-ment strategy.展开更多
Esophageal diverticula are rare conditions that cause esophageal symptoms,such as dysphagia,regurgitation,and chest pain.They are classified according to their location and characteristic pathophysiology into three ty...Esophageal diverticula are rare conditions that cause esophageal symptoms,such as dysphagia,regurgitation,and chest pain.They are classified according to their location and characteristic pathophysiology into three types:epiphrenic diverticulum,Zenker's diverticulum,and Rokitansky diverticulum.The former two disorders take the form of protrusions,and symptomatic cases require interventional treatment.However,the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum,particularly when it is located closer to the oral orifice.Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms.Several types of endoscopic devices and techniques are currently employed,including peroral endoscopic myotomy(POEM).However,the use of minimally invasive endoscopic approaches,like POEM,has allowed the development of new disorder called iatrogenic esophageal diverticula.In this paper,we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.展开更多
We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to perman...We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.展开更多
BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter amp...BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter ampullary anatomy,increasing technical difficulty during ERCP,existing studies report inconsistent findings on its role in PEP pathogenesis.We hypothesize that PAD presence,particularly type B,shows a significant association with PEP development and may interact with procedural factors like pancreatic duct guidewire insertion.AIM To examine the association between PAD(including subtypes A/B)and PEP incidence after ERCP for choledocholithiasis.METHODS We conducted a retrospective cohort study of 615 patients undergoing ERCP at two tertiary hospitals from 2023 to 2025.Participants were stratified into PAD(n=183;subtype A=125,subtype B=58)and non-PAD(n=432)groups.The primary outcome was PEP incidence.Multivariable logistic regression adjusted for age,sex,hypertension,diabetes,gallbladder surgery,and guidewire insertion.Statistical significance was set at P<0.05(two-tailed).RESULTS PAD prevalence was 29.8%(183/615).PEP occurrence was more frequent in PAD patients[15.3%(28/183)]than in non-PAD patients[4.2%(18/432)],odds ratio(OR)=3.86,95%confidence interval:2.03-7.35,P<0.001.Type B PAD showed a stronger association with PEP than type A(OR=14.16,95%confidence interval:5.84-34.34,P<0.001).Guidewire pancreatic duct entry was linked to higher PEP odds in PAD patients(adjusted OR=5.02,P<0.05).Hypertension also demonstrated an association with PEP in the PAD subgroup(P=0.012).CONCLUSION PAD,particularly type B,is independently associated with PEP after ERCP.Patients with these features,especially those with hypertension or pancreatic duct instrumentation,may benefit from enhanced monitoring and prophylaxis.展开更多
BACKGROUND Enhanced recovery after surgery(ERAS)guidelines have been established for multiple types of adult surgeries.However,ERAS guidelines tailored to pediatric surgeries remain to be developed.AIM To evaluate the...BACKGROUND Enhanced recovery after surgery(ERAS)guidelines have been established for multiple types of adult surgeries.However,ERAS guidelines tailored to pediatric surgeries remain to be developed.AIM To evaluate the clinical outcomes of ERAS protocols in pediatric laparoscopic Meckel’s diverticulum resection.METHODS This retrospective cohort study analyzed 78 consecutive pediatric cases treated between January 2017 and March 2025.Patients were divided into:Traditional care group(n=38):January 2017-December 2020;ERAS protocol group(n=40):January 2021-March 2025.We compared perioperative outcomes,including clinical recovery parameters and laboratory markers,to assess protocol efficacy.RESULTS All procedures were completed laparoscopically by the same surgical team without conversion.Baseline characteristics,including demographics,diverticulum location,and intraoperative parameters(operative time,blood loss),were comparable between groups(all P>0.05).The ERAS protocol demonstrated significantly shorter postoperative length of stay(7.55±1.52 days vs 10.40±3.59 days,P<0.001)while complication rates were numerically lower in the ERAS group(17.50%vs 13.16%,P=0.595).Additional benefits of ERAS implementation included:Reduced intravenous fluid requirements(5.00 mL/kg/hour vs 8.00 mL/kg/hour),accelerated gastrointestinal recovery(first flatus:2.00 days vs 3.00 days),lower pain scores(P<0.001),earlier total enteral nutrition achievement(5.00 days vs 6.50 days)and shorter intravenous therapy duration(6.00 days vs 8.00 days;all P<0.001).ERAS patients also showed reduced drainage utilization(P<0.05)and improved inflammatory marker profiles postoperatively[neutrophils:(5.98±2.02)×10^(9)/L vs(8.01±3.98)×10^(9)/L];median Creactive protein:13.6 mg/L 7 vs 19.63 mg/L).Glycemic control was superior in the ERAS group despite higher induction levels(both P<0.05).Parental satisfaction(92.50%vs 86.84%)and 30-day readmission rates(2.50%vs 2.63%)showed no significant differences.CONCLUSION ERAS protocols safely optimize recovery in children undergoing laparoscopic Meckel’s diverticulum resection,significantly reducing length of stay while improving pain management and overall clinical outcomes.These findings support the adoption of ERAS in pediatric intestinal surgery.展开更多
BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion o...BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion of the inner esophageal wall. Midesophagealdiverticula are relatively rare and may coexist with diffuse esophagealspasm. However, the potential esophageal motility disorders associated withthese lesions are frequently overlooked in clinical practice. The use of endoscopicinterventions may offer a novel approach for the alleviation of dysphagia associatedwith this condition.CASE SUMMARYWe present a case of a 74-year-old woman with dysphagia, diagnosed with midesophagealdiverticulum and diffuse esophageal spasm. Due to her physical condition,submucosal tunneling endoscopic septum division (STESD) was initiallyperformed for the diverticulum. One month later, the esophageal spasm wastreated using per-oral endoscopic myotomy (POEM). This combined treatmentsignificantly improved her dysphagia, and she was discharged.CONCLUSIONSTESD and POEM are effective and safe for the treatment of dysphagia caused bymid-esophageal diverticula with diffuse esophageal spasm.展开更多
BACKGROUND Bleeding from Zenker’s diverticulum is extremely rare.At present,there are no guidelines for the management of bleeding Zenker’s diverticulum because of its rarity.Per-oral endoscopic myotomy(Z-POEM)is a ...BACKGROUND Bleeding from Zenker’s diverticulum is extremely rare.At present,there are no guidelines for the management of bleeding Zenker’s diverticulum because of its rarity.Per-oral endoscopic myotomy(Z-POEM)is a precision myotomy technique and minimally invasive procedure for the treatment of Zenker’s diverticulum.We present a systematic review and a rare case of bleeding Zenker’s diverticulum that was effectively treated using Z-POEM.CASE SUMMARY A 72-year-old presented after 3 d of hematemesis.He had a 2-year history of progressive dysphagia and reported no antiplatelet,anticoagulant,or nonsteroidal anti-inflammatory drug use.His vital signs were stable,and the hematocrit was 36%.Previous gastroscopy and barium swallow had revealed Zenker’s diverticulum before the bleeding occurred.We performed gastroscopy and found a 5-mm ulcer with a minimal blood clot and spontaneously resolved bleeding.Z-POEM for definitive treatment was performed to reduce accumulation of food and promote ulcer healing.He had no complications and no bleeding;at the follow-up 6 mo later,the ulcer was healed.CONCLUSION Z-POEM can be definitive prevention for bleeding ulcer in Zenker’s diverticulum that promotes ulcer healing,reducing the risk of recurrent bleeding.Z-POEM is also a definitive endoscopic surgery for treatment of Zenker’s diverticulum.展开更多
Meckel's diverticulum(MD) results from incomplete involution of the proximal portion of the vitelline(also known as the omphalomesenteric) duct during weeks 5-7 of foetal development. Although MD is the most commo...Meckel's diverticulum(MD) results from incomplete involution of the proximal portion of the vitelline(also known as the omphalomesenteric) duct during weeks 5-7 of foetal development. Although MD is the most commonly diagnosed congenital gastrointestinal anom-aly, it is estimated to affect only 2% of the population worldwide. Most cases are asymptomatic, and diagno-sis is often made following investigation of unexplained gastrointestinal bleeding, perforation, inflammation or obstruction that prompt clinic presentation. While MD range in size from 1-10 cm, cases of giant MD(≥ 5 cm) are relatively rare and associated with more severe forms of the complications, especially for obstruction. Herein, we report a case of giant MD with secondary small bowel obstruction in an adult male that was suc-cessfully managed by surgical resection and anasto-mosis created with endoscopic stapler device(80 mm, endo-GIA stapler). Patient was discharged on post-operative day 6 without any complications. Histopatho-logic examination indicated Meckel's diverticulitis with-out gastric or pancreatic metaplasia.展开更多
A Killian-Jamieson diverticulum （KID） is an unfamiliar and rare cervical esophageal diverticulum. This diverticulum originates on the anterolateral wall of the proximal cervical esophagus through a muscular gap （th...A Killian-Jamieson diverticulum （KID） is an unfamiliar and rare cervical esophageal diverticulum. This diverticulum originates on the anterolateral wall of the proximal cervical esophagus through a muscular gap （the Killian-Jamieson space） below the cricopharyngeal muscle and lateral to the longitudinal muscle of the esophagus. To date, only surgical treatment has been recommended for a symptomatic KJD due to its close proximity to the recurrent laryngeal nerve and the concern of possible nerve injury. Recently, traditional open surgery for a symptomatic KJD is being challenged by the development of new endoscopic techniques and devices. We present here a case of a symptomatic KID that was successfully treated with the flexible endoscopic diverticulotomy using two new devices. An isolated-tip needle-knife papillotome （Iso-Tome） was used for the dissection of the tissue bridge of the diverticulum. And a flexible overtube with a modified distal end （a fitted overtube） was used for adequate visualization of the tissue bridge of the diverticulum and protection of the surrounding tissue during dissection of the tissue bridge. Our successful experience suggests that the flexible endoscopic diverticulotomy with the use of appropriate endoscopicdevices can be a safe and effective method for the treatment of a symptomatic KJD.展开更多
BACKGROUND Hutch diverticulum arises from the compromised muscular development at the ureteral orifice.It is a congenital disease and extremely rare in adult,only accounting for about 3%occurrence worldwide.It can be ...BACKGROUND Hutch diverticulum arises from the compromised muscular development at the ureteral orifice.It is a congenital disease and extremely rare in adult,only accounting for about 3%occurrence worldwide.It can be either symptomatic or asymptomatic,and relies on image tools for diagnosis and preoperative planning.Indications for surgery are dependent on the complications from the diverticulum.Metaplasia is about 10%among those with hutch diverticulum,and it still has chances turning into malignancy,especially urothelial cell carcinoma.CASE SUMMARY A 27-year-old man was presented with frequently recurrent urinary tract infection for one year,and had suffered from intermittent right flank pain for 3 mo.No past medical histories were recorded before.No obvious abnormalities on laboratory data and urine examination were found.Under ultrasound,right hydronephrosis was seen and an anatomical abnormality was observed on intravenous pyelography.Further computed tomography urogram showed one diverticulum seated at superolateral side of right ureteral orifice.Cystoscopy was done and biopsy results showed focal metaplasia.After discussing with him,roboticassisted diverticulectomy with reconstruction was performed.Right hydronephrosis was greatly improved after surgery.He has completed his 1.5-year follow-ups,and no malignancies were seen from urine cytology and image of intravenous pyelography.CONCLUSION Robotic-assisted diverticulectomy and reconstruction to hutch diverticulum is a safe and efficient operation,providing several advantages over open and laparoscopic ones.展开更多
BACKGROUND:Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classification in 1977. The classification is the most extensively used,but does not include some rare variations.We present ...BACKGROUND:Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classification in 1977. The classification is the most extensively used,but does not include some rare variations.We present a case of hepatic duct diverticulum,one of the variations,and discuss its diagnosis and treatment. METHODS:A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and vomiting.She was finally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT:The patient underwent resection of the hepatic duct diverticulum and cholecystectomy,and was asymptomatic 26 months after surgery. CONCLUSIONS:Hepatic duct diverticulum is a rare form of choledochal cyst,not included in Todani’s classification. Todani’s classification including this and other uncommon variations of choledochal cysts must be reviewed.The best diagnostic imaging methods and treatment for choledochal cysts must be defined.展开更多
BACKGROUND: The presence of intraduodenal periampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China ...BACKGROUND: The presence of intraduodenal periampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal periampullary diverticulum and biliary disease, especially the formation of bile duct pigment stones. METHODS: A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy (EST) were studied retrospectively. They were divided into 6 groups according to the category of biliary disease, and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones. RESULTS: There were 44 patients with intraduodenal periampullary diverticulum in 81 patients with primary bile duct pigment stones (54.32%), 4 in 8 patients with bile duct stones and gallbladder stones (50%), 7 in 33 patients with bile duct stones secondary to gallbladder stones (21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla (14.29%), 1 in 22 patients with carcinoma of the end of the bile duct and papilla (4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction (38.46%). CONCLUSIONS: The incidence rate of intraduodenal periampullary diverticulum in patients with primary bile duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones.展开更多
Periampullary diverticulum(PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD isusua...Periampullary diverticulum(PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD isusually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography(ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD,suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation.展开更多
AIM: To retrospective review the laparoscopic management of Meckel Diverticulum(MD) in two Italian Pediatric Surgery Centers.METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted(TU...AIM: To retrospective review the laparoscopic management of Meckel Diverticulum(MD) in two Italian Pediatric Surgery Centers.METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted(TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years(range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was establishedbased on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients' demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed.RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min(range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d(range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years(range 10 mo-10 years).CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel's diverticulectomy is safe and effective in the treatment of MD, with excellent results.展开更多
Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity...Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report two cases of intussusception due to MD in adults. A diverticulectomy using a TA stapler was performed in the first patient. In the second patient extensive fibrosis of the adjacent mesentery and thickening of jejunal mucosa were observed, so a segmental resection of the small bowel or affected ileal part and a hand-sewn anastomosis was performed. The postoperative period along with the long term follow-up was uneventful for both patients. The decision between diverticulectomy vs bowel resection can be based on the intussuscepted bowel condition. Early surgical intervention may ensure a favorable outcome.展开更多
Meckel's diverticulum(MD)is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage,obstruction,and inflammation.Obstruction ...Meckel's diverticulum(MD)is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage,obstruction,and inflammation.Obstruction of various types is the most common presenting symptom in the adult population.Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications.The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies.Delay in the diagnosis of a complicated MD can lead to signifi- cant morbidity and mortality.Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum.To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.展开更多
Lipoma within an inverted Meckel's diverticulum presen- ting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity. We report a case of 47-year-old male with a history of recurrent e...Lipoma within an inverted Meckel's diverticulum presen- ting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity. We report a case of 47-year-old male with a history of recurrent episodes of partial intestinal obstruction and melena due to a subserosal lipoma located in the base of an inverted Meckel's diverticulum. According to our knowledge, this is the first case of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario without the existence of heterotrophic gastric or pancreatic tissues.展开更多
BACKGROUND Different types of periampullary diverticulum(PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography(ERCP) cannulation,but the clinical significance of the two current ...BACKGROUND Different types of periampullary diverticulum(PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography(ERCP) cannulation,but the clinical significance of the two current PAD classifications for cannulation is limited.AIM To verify the clinical value of our newly proposed PAD classification.METHODS A new PAD classification(Li-Tanaka classification) was proposed at our center.All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.RESULTS A total of 3564 patients with native papillae were enrolled, including 967(27.13%)PAD patients and 2597(72.87%) non-PAD patients. In the Li-Tanaka classification, type Ⅰ PAD patients exhibited the highest difficult cannulation rate(23.1%, P = 0.01), and type Ⅱ and Ⅳ patients had the highest cannulation success rates(99.4% in type Ⅱ and 99.3% in type Ⅳ, P < 0.001). In a multivariableadjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio(OR) = 1.87, 95% confidence interval(CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group,the difficulty of cannulation in the type Ⅰ PAD group according to the Li-Tanaka classification was greater(OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower(OR = 0.27, 95%CI: 0.11-0.66, P < 0.001),while it was higher in the type Ⅱ PAD group(OR = 4.44, 95%CI: 1.61-12.29, P <0.01).CONCLUSION Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.展开更多
AIM: To investigate the clinical presentation,diagnosis,and treatment of giant colonic diverticulum(GCD,by means of a complete and updated literature review).GCD is a rare manifestation of diverticular disease of the ...AIM: To investigate the clinical presentation,diagnosis,and treatment of giant colonic diverticulum(GCD,by means of a complete and updated literature review).GCD is a rare manifestation of diverticular disease of the colon.Less than 200 studies on GCD were published in the literature,predominantly case reports or small patient series.METHODS: A systematic review of the literature was performed using the Embase and PubM ed databases toidentify all the GCD studies.The following MESH search headings were used: "giant colonic diverticulum"; "giant sigmoid diverticulum".The "related articles" function was used to broaden the search,and all of the abstracts,studies,and citations were reviewed by two authors.The following outcomes were of interest: the disease and patient characteristics,study design,indications for surgery,type of operation,and postoperative outcomes.Additionally,a subgroup analysis of cases treated in the last 5 years was performed to show the current trends in the treatment of GCD.A GCD case in an elderly patient treated in our department by a sigmoidectomy with primary anastomosis and a diverting ileostomy is presented as a typical example of the disease.RESULTS: In total,166 GCD cases in 138 studies were identified in the literature.The most common clinical presentation was abdominal pain,which occurred in 69% of the cases.Among the physical signs,an abdominal mass was detected in 48% of the cases,whereas 20% of the patients presented with fever and 14% with abdominal tenderness.Diagnosis is based predominantly on abdominal computed tomography.The most frequent treatment was colic resection with en-bloc resection of the diverticulum,performed in 57.2% of cases,whereas Hartmann's procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%.An analysis of sixteen cases reported in the last 5 years showed that the majority of patients were treated with sigmoidectomy and en-bloc resection of the diverticulum; the postoperative mortality was null,morbidity was very low(1 patient was hospitalized in the intensive care unit for postoperative hypotension),and the patients were discharged 4-14 d after surgery.CONCLUSION: Giant colonic diverticulum is a rare manifestation of diverticular diseases.Surgical treatment,consisting predominantly of colonic resection with en bloc resection of the diverticulum,is thepreferred option for GCD and guarantees excellent results.展开更多
基金Supported by the Department of Science and Technology of Liaoning Province,No.2024JH2/102600288.
文摘Esophageal diverticulum can be broadly classified into three main types:Phar-yngoesophageal diverticulum located near the upper esophageal sphincter(including Zenker’s diverticulum,Killian-Jamieson diverticulum,and Laimer’s diverticulum);Mid-esophageal diverticulum,and epiphrenic diverticulum loca-ted just above the lower esophageal sphincter.Most asymptomatic esophageal diverticulum are incidentally detected during routine imaging studies,such as barium swallow,computed tomography scans,or esophagogastroduodenoscopy.For these patients,regular follow-up is typically sufficient.However,a small subset may experience persistent symptoms such as dysphagia and acid reflux.Patients with symptomatic diverticulum should be assessed for the potential need for surgical intervention to prevent serious complications,including aspiration pneumonia and malnutrition.The treatment options for symptomatic esophageal diverticulum encompass both endoscopic and surgical approaches.Due to the technical complexity and significant risks associated with surgical intervention,endoscopic treatment has gained increasing preference,achieving remarkable results with the advancements in endoscopic instruments and techniques.Given the anatomical location and pathophysiological differences among esophageal diverticulum,a personalized endoscopic strategy is essential to achieve optimal results.This review provides an overview of the characteristics of esophageal diverticulum and offers a comprehensive discussion of diverticular peroral endoscopic myotomy and its related variations as the primary endoscopic treat-ment strategy.
文摘Esophageal diverticula are rare conditions that cause esophageal symptoms,such as dysphagia,regurgitation,and chest pain.They are classified according to their location and characteristic pathophysiology into three types:epiphrenic diverticulum,Zenker's diverticulum,and Rokitansky diverticulum.The former two disorders take the form of protrusions,and symptomatic cases require interventional treatment.However,the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum,particularly when it is located closer to the oral orifice.Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms.Several types of endoscopic devices and techniques are currently employed,including peroral endoscopic myotomy(POEM).However,the use of minimally invasive endoscopic approaches,like POEM,has allowed the development of new disorder called iatrogenic esophageal diverticula.In this paper,we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.
文摘We report a case involving an 85-year-old man who underwent laparoscopic radical prostatectomy for prostate cancer in 2011.During follow-up,he required long-term use of a penile clamp to manage urination due to permanent severe stress incontinence.In February 2023,he presented with a painless cystic mass in the scrotum.Upon pressing the mass with hand,fluid drained from the external urethral orifice,causing the mass to shrink in size,although it returned to its original size a few hours later.Urography and cystoscopy showed a globular urethral diverticulum located anteriorly.The patient underwent surgical excision of the diverticulum along with urethroplasty.Postoperatively,the urinary stress incontinence persisted,but he declined any further surgical intervention.An artificial urinary sphincter is currently the first-line treatment for male urinary incontinence.However,devices such as penile clamps can serve as an alternative when considering surgical suitability or cost.It is important to note that these devices can lead to serious complications such as urethral erosion,stricture,or diverticulum.Therefore,caution is advised when using such devices,and they should be removed periodically at short intervals.
文摘BACKGROUND Periampullary diverticulum(PAD)is a common anatomical variant,but its association with post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)remains controversial.While PAD may alter ampullary anatomy,increasing technical difficulty during ERCP,existing studies report inconsistent findings on its role in PEP pathogenesis.We hypothesize that PAD presence,particularly type B,shows a significant association with PEP development and may interact with procedural factors like pancreatic duct guidewire insertion.AIM To examine the association between PAD(including subtypes A/B)and PEP incidence after ERCP for choledocholithiasis.METHODS We conducted a retrospective cohort study of 615 patients undergoing ERCP at two tertiary hospitals from 2023 to 2025.Participants were stratified into PAD(n=183;subtype A=125,subtype B=58)and non-PAD(n=432)groups.The primary outcome was PEP incidence.Multivariable logistic regression adjusted for age,sex,hypertension,diabetes,gallbladder surgery,and guidewire insertion.Statistical significance was set at P<0.05(two-tailed).RESULTS PAD prevalence was 29.8%(183/615).PEP occurrence was more frequent in PAD patients[15.3%(28/183)]than in non-PAD patients[4.2%(18/432)],odds ratio(OR)=3.86,95%confidence interval:2.03-7.35,P<0.001.Type B PAD showed a stronger association with PEP than type A(OR=14.16,95%confidence interval:5.84-34.34,P<0.001).Guidewire pancreatic duct entry was linked to higher PEP odds in PAD patients(adjusted OR=5.02,P<0.05).Hypertension also demonstrated an association with PEP in the PAD subgroup(P=0.012).CONCLUSION PAD,particularly type B,is independently associated with PEP after ERCP.Patients with these features,especially those with hypertension or pancreatic duct instrumentation,may benefit from enhanced monitoring and prophylaxis.
文摘BACKGROUND Enhanced recovery after surgery(ERAS)guidelines have been established for multiple types of adult surgeries.However,ERAS guidelines tailored to pediatric surgeries remain to be developed.AIM To evaluate the clinical outcomes of ERAS protocols in pediatric laparoscopic Meckel’s diverticulum resection.METHODS This retrospective cohort study analyzed 78 consecutive pediatric cases treated between January 2017 and March 2025.Patients were divided into:Traditional care group(n=38):January 2017-December 2020;ERAS protocol group(n=40):January 2021-March 2025.We compared perioperative outcomes,including clinical recovery parameters and laboratory markers,to assess protocol efficacy.RESULTS All procedures were completed laparoscopically by the same surgical team without conversion.Baseline characteristics,including demographics,diverticulum location,and intraoperative parameters(operative time,blood loss),were comparable between groups(all P>0.05).The ERAS protocol demonstrated significantly shorter postoperative length of stay(7.55±1.52 days vs 10.40±3.59 days,P<0.001)while complication rates were numerically lower in the ERAS group(17.50%vs 13.16%,P=0.595).Additional benefits of ERAS implementation included:Reduced intravenous fluid requirements(5.00 mL/kg/hour vs 8.00 mL/kg/hour),accelerated gastrointestinal recovery(first flatus:2.00 days vs 3.00 days),lower pain scores(P<0.001),earlier total enteral nutrition achievement(5.00 days vs 6.50 days)and shorter intravenous therapy duration(6.00 days vs 8.00 days;all P<0.001).ERAS patients also showed reduced drainage utilization(P<0.05)and improved inflammatory marker profiles postoperatively[neutrophils:(5.98±2.02)×10^(9)/L vs(8.01±3.98)×10^(9)/L];median Creactive protein:13.6 mg/L 7 vs 19.63 mg/L).Glycemic control was superior in the ERAS group despite higher induction levels(both P<0.05).Parental satisfaction(92.50%vs 86.84%)and 30-day readmission rates(2.50%vs 2.63%)showed no significant differences.CONCLUSION ERAS protocols safely optimize recovery in children undergoing laparoscopic Meckel’s diverticulum resection,significantly reducing length of stay while improving pain management and overall clinical outcomes.These findings support the adoption of ERAS in pediatric intestinal surgery.
基金Supported by Natural Science Foundation of Shandong Province,No.81700472Clinical+X Project Fund of Binzhou Medical College,No.BY2021LCX11and Binzhou Medical University Science and Technology Program Projects,No.BY2019KJ13.
文摘BACKGROUNDA mid-esophageal diverticulum is an outpouching located in the midsection ofthe esophagus, posterior to the bifurcation of the right and left bronchi. The conditionis characterized by an outward protrusion of the inner esophageal wall. Midesophagealdiverticula are relatively rare and may coexist with diffuse esophagealspasm. However, the potential esophageal motility disorders associated withthese lesions are frequently overlooked in clinical practice. The use of endoscopicinterventions may offer a novel approach for the alleviation of dysphagia associatedwith this condition.CASE SUMMARYWe present a case of a 74-year-old woman with dysphagia, diagnosed with midesophagealdiverticulum and diffuse esophageal spasm. Due to her physical condition,submucosal tunneling endoscopic septum division (STESD) was initiallyperformed for the diverticulum. One month later, the esophageal spasm wastreated using per-oral endoscopic myotomy (POEM). This combined treatmentsignificantly improved her dysphagia, and she was discharged.CONCLUSIONSTESD and POEM are effective and safe for the treatment of dysphagia caused bymid-esophageal diverticula with diffuse esophageal spasm.
文摘BACKGROUND Bleeding from Zenker’s diverticulum is extremely rare.At present,there are no guidelines for the management of bleeding Zenker’s diverticulum because of its rarity.Per-oral endoscopic myotomy(Z-POEM)is a precision myotomy technique and minimally invasive procedure for the treatment of Zenker’s diverticulum.We present a systematic review and a rare case of bleeding Zenker’s diverticulum that was effectively treated using Z-POEM.CASE SUMMARY A 72-year-old presented after 3 d of hematemesis.He had a 2-year history of progressive dysphagia and reported no antiplatelet,anticoagulant,or nonsteroidal anti-inflammatory drug use.His vital signs were stable,and the hematocrit was 36%.Previous gastroscopy and barium swallow had revealed Zenker’s diverticulum before the bleeding occurred.We performed gastroscopy and found a 5-mm ulcer with a minimal blood clot and spontaneously resolved bleeding.Z-POEM for definitive treatment was performed to reduce accumulation of food and promote ulcer healing.He had no complications and no bleeding;at the follow-up 6 mo later,the ulcer was healed.CONCLUSION Z-POEM can be definitive prevention for bleeding ulcer in Zenker’s diverticulum that promotes ulcer healing,reducing the risk of recurrent bleeding.Z-POEM is also a definitive endoscopic surgery for treatment of Zenker’s diverticulum.
文摘Meckel's diverticulum(MD) results from incomplete involution of the proximal portion of the vitelline(also known as the omphalomesenteric) duct during weeks 5-7 of foetal development. Although MD is the most commonly diagnosed congenital gastrointestinal anom-aly, it is estimated to affect only 2% of the population worldwide. Most cases are asymptomatic, and diagno-sis is often made following investigation of unexplained gastrointestinal bleeding, perforation, inflammation or obstruction that prompt clinic presentation. While MD range in size from 1-10 cm, cases of giant MD(≥ 5 cm) are relatively rare and associated with more severe forms of the complications, especially for obstruction. Herein, we report a case of giant MD with secondary small bowel obstruction in an adult male that was suc-cessfully managed by surgical resection and anasto-mosis created with endoscopic stapler device(80 mm, endo-GIA stapler). Patient was discharged on post-operative day 6 without any complications. Histopatho-logic examination indicated Meckel's diverticulitis with-out gastric or pancreatic metaplasia.
文摘A Killian-Jamieson diverticulum （KID） is an unfamiliar and rare cervical esophageal diverticulum. This diverticulum originates on the anterolateral wall of the proximal cervical esophagus through a muscular gap （the Killian-Jamieson space） below the cricopharyngeal muscle and lateral to the longitudinal muscle of the esophagus. To date, only surgical treatment has been recommended for a symptomatic KJD due to its close proximity to the recurrent laryngeal nerve and the concern of possible nerve injury. Recently, traditional open surgery for a symptomatic KJD is being challenged by the development of new endoscopic techniques and devices. We present here a case of a symptomatic KID that was successfully treated with the flexible endoscopic diverticulotomy using two new devices. An isolated-tip needle-knife papillotome （Iso-Tome） was used for the dissection of the tissue bridge of the diverticulum. And a flexible overtube with a modified distal end （a fitted overtube） was used for adequate visualization of the tissue bridge of the diverticulum and protection of the surrounding tissue during dissection of the tissue bridge. Our successful experience suggests that the flexible endoscopic diverticulotomy with the use of appropriate endoscopicdevices can be a safe and effective method for the treatment of a symptomatic KJD.
文摘BACKGROUND Hutch diverticulum arises from the compromised muscular development at the ureteral orifice.It is a congenital disease and extremely rare in adult,only accounting for about 3%occurrence worldwide.It can be either symptomatic or asymptomatic,and relies on image tools for diagnosis and preoperative planning.Indications for surgery are dependent on the complications from the diverticulum.Metaplasia is about 10%among those with hutch diverticulum,and it still has chances turning into malignancy,especially urothelial cell carcinoma.CASE SUMMARY A 27-year-old man was presented with frequently recurrent urinary tract infection for one year,and had suffered from intermittent right flank pain for 3 mo.No past medical histories were recorded before.No obvious abnormalities on laboratory data and urine examination were found.Under ultrasound,right hydronephrosis was seen and an anatomical abnormality was observed on intravenous pyelography.Further computed tomography urogram showed one diverticulum seated at superolateral side of right ureteral orifice.Cystoscopy was done and biopsy results showed focal metaplasia.After discussing with him,roboticassisted diverticulectomy with reconstruction was performed.Right hydronephrosis was greatly improved after surgery.He has completed his 1.5-year follow-ups,and no malignancies were seen from urine cytology and image of intravenous pyelography.CONCLUSION Robotic-assisted diverticulectomy and reconstruction to hutch diverticulum is a safe and efficient operation,providing several advantages over open and laparoscopic ones.
文摘BACKGROUND:Douglas described choledochal cysts in 1852 and Todani proposed an anatomy-based classification in 1977. The classification is the most extensively used,but does not include some rare variations.We present a case of hepatic duct diverticulum,one of the variations,and discuss its diagnosis and treatment. METHODS:A 57-year-old woman presented with upper abdominal pain and discomfort associated with nausea and vomiting.She was finally diagnosed with cholelithiasis and right hepatic duct diverticulum. RESULT:The patient underwent resection of the hepatic duct diverticulum and cholecystectomy,and was asymptomatic 26 months after surgery. CONCLUSIONS:Hepatic duct diverticulum is a rare form of choledochal cyst,not included in Todani’s classification. Todani’s classification including this and other uncommon variations of choledochal cysts must be reviewed.The best diagnostic imaging methods and treatment for choledochal cysts must be defined.
文摘BACKGROUND: The presence of intraduodenal periampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal periampullary diverticulum and biliary disease, especially the formation of bile duct pigment stones. METHODS: A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy (EST) were studied retrospectively. They were divided into 6 groups according to the category of biliary disease, and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated. duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones. RESULTS: There were 44 patients with intraduodenal periampullary diverticulum in 81 patients with primary bile duct pigment stones (54.32%), 4 in 8 patients with bile duct stones and gallbladder stones (50%), 7 in 33 patients with bile duct stones secondary to gallbladder stones (21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla (14.29%), 1 in 22 patients with carcinoma of the end of the bile duct and papilla (4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction (38.46%). CONCLUSIONS: The incidence rate of intraduodenal periampullary diverticulum in patients with primary bile duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones.
文摘Periampullary diverticulum(PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD isusually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography(ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD,suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation.
文摘AIM: To retrospective review the laparoscopic management of Meckel Diverticulum(MD) in two Italian Pediatric Surgery Centers.METHODS: Between January 2002 and December 2012, 19 trans-umbilical laparoscopic-assisted(TULA) procedures were performed for suspected MD. The children were hospitalized for gastrointestinal bleeding and/or recurrent abdominal pain. Median age at diagnosis was 5.4 years(range 6 mo-15 years). The study included 15 boys and 4 girls. All patients underwent clinical examination, routine laboratory tests, abdominal ultrasound and technetium-99m pertechnetate scan, and patients with bleeding underwent gastrointestinal endoscopy. The abdominal exploration was performed with a 10 mm operative laparoscope. Pneumoperitoneum was establishedbased on the body weight. Systematic overview of the peritoneal cavity allowed the ileum to be grasped with an atraumatic instrument. The complete exploration and surgical treatment of MD were performed extracorporeally, after intestinal exteriorization through the umbilicus. All patients' demographics, main clinical features, diagnostic investigations, operative time, histopathology reports, conversion rate, hospital stay and complications were registered and analyzed.RESULTS: MD was identified in 17 patients, while 1 had an ileal duplication and 1 a jejunal hemangioma. Fifteen patients had painless intestinal bleeding, while 4 had recurrent abdominal pain and exhibited cyst like structures in an ultrasound study. Eleven patients had a positive technetium-99m pertechnetate scan. In the patients with bleeding, gastrointestinal endoscopy did not name the source of hemorrhage. All patients were subjected to a TULA surgical procedure. An intestinal resection/anastomosis was performed in 14 patients, while 4 had a wedge resection of the diverticulum and 1 underwent stapling diverticulectomy. All surgical procedures were performed without conversion to open laparotomy. Mean operative time was 75 min(range 40-115 min). No major surgical complications were recorded. The median hospital stay was 5-7 d(range 4-13 d). All patients are asymptomatic at a median follow up of 4, 5 years(range 10 mo-10 years).CONCLUSION: Trans-umbilical laparoscopic-assisted Meckel's diverticulectomy is safe and effective in the treatment of MD, with excellent results.
文摘Adult intussusception due to Meckel’s diverticulum (MD) is an uncommon cause of intestinal obstruction. However, the surgeon should still be suspicious of this condition since the non specific symptoms and the rarity of it make a preoperative diagnosis uncertain. Considering the secondary nature of adult intussusception and the necessity of early surgical intervention to avoid morbidity and mortality, we report two cases of intussusception due to MD in adults. A diverticulectomy using a TA stapler was performed in the first patient. In the second patient extensive fibrosis of the adjacent mesentery and thickening of jejunal mucosa were observed, so a segmental resection of the small bowel or affected ileal part and a hand-sewn anastomosis was performed. The postoperative period along with the long term follow-up was uneventful for both patients. The decision between diverticulectomy vs bowel resection can be based on the intussuscepted bowel condition. Early surgical intervention may ensure a favorable outcome.
文摘Meckel's diverticulum(MD)is considered the most prevalent congenital anomaly of the gastrointestinal tract. It may result in a number of complications including hemorrhage,obstruction,and inflammation.Obstruction of various types is the most common presenting symptom in the adult population.Loop formations with the end of an MD and adjacent mesentery constricting the distal ileum is an uncommon cause of obstruction. Axial torsion and gangrene of MD is the rarest of the complications.The correct diagnosis of complicated MD before surgery is often difficult because this condition may mimic other acute abdominal pathologies.Delay in the diagnosis of a complicated MD can lead to signifi- cant morbidity and mortality.Here we describe the case of a patient with a very rare form of acute small bowel obstruction secondary to giant torsed gangrenous MD encircling the terminal ileum.To our knowledge, this co-occurrence of axial torsion and a loop-forming mechanism of obstruction has been reported only once in English medical literature.
文摘Lipoma within an inverted Meckel's diverticulum presen- ting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity. We report a case of 47-year-old male with a history of recurrent episodes of partial intestinal obstruction and melena due to a subserosal lipoma located in the base of an inverted Meckel's diverticulum. According to our knowledge, this is the first case of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario without the existence of heterotrophic gastric or pancreatic tissues.
基金Supported by the National Natural Science Foundation of China,NO.31570509.
文摘BACKGROUND Different types of periampullary diverticulum(PAD) may differentially affect the success of endoscopic retrograde cholangiopancreatography(ERCP) cannulation,but the clinical significance of the two current PAD classifications for cannulation is limited.AIM To verify the clinical value of our newly proposed PAD classification.METHODS A new PAD classification(Li-Tanaka classification) was proposed at our center.All PAD patients with native papillae who underwent ERCP from January 2012 to December 2017 were classified according to three classification systems, and the effects of various types of PAD on ERCP cannulation were compared.RESULTS A total of 3564 patients with native papillae were enrolled, including 967(27.13%)PAD patients and 2597(72.87%) non-PAD patients. In the Li-Tanaka classification, type Ⅰ PAD patients exhibited the highest difficult cannulation rate(23.1%, P = 0.01), and type Ⅱ and Ⅳ patients had the highest cannulation success rates(99.4% in type Ⅱ and 99.3% in type Ⅳ, P < 0.001). In a multivariableadjusted logistic model, the overall successful cannulation rate in PAD patients was higher than that in non-PAD patients [odds ratio(OR) = 1.87, 95% confidence interval(CI): 1.04-3037, P = 0.037]. In addition, compared to the non-PAD group,the difficulty of cannulation in the type Ⅰ PAD group according to the Li-Tanaka classification was greater(OR = 2.04, 95%CI: 1.13-3.68, P = 0.004), and the successful cannulation rate was lower(OR = 0.27, 95%CI: 0.11-0.66, P < 0.001),while it was higher in the type Ⅱ PAD group(OR = 4.44, 95%CI: 1.61-12.29, P <0.01).CONCLUSION Among the three PAD classifications, the Li-Tanaka classification has an obvious clinical advantage for ERCP cannulation, and it is helpful for evaluating potentially difficult and successful cannulation cases among different types of PAD patients.
文摘AIM: To investigate the clinical presentation,diagnosis,and treatment of giant colonic diverticulum(GCD,by means of a complete and updated literature review).GCD is a rare manifestation of diverticular disease of the colon.Less than 200 studies on GCD were published in the literature,predominantly case reports or small patient series.METHODS: A systematic review of the literature was performed using the Embase and PubM ed databases toidentify all the GCD studies.The following MESH search headings were used: "giant colonic diverticulum"; "giant sigmoid diverticulum".The "related articles" function was used to broaden the search,and all of the abstracts,studies,and citations were reviewed by two authors.The following outcomes were of interest: the disease and patient characteristics,study design,indications for surgery,type of operation,and postoperative outcomes.Additionally,a subgroup analysis of cases treated in the last 5 years was performed to show the current trends in the treatment of GCD.A GCD case in an elderly patient treated in our department by a sigmoidectomy with primary anastomosis and a diverting ileostomy is presented as a typical example of the disease.RESULTS: In total,166 GCD cases in 138 studies were identified in the literature.The most common clinical presentation was abdominal pain,which occurred in 69% of the cases.Among the physical signs,an abdominal mass was detected in 48% of the cases,whereas 20% of the patients presented with fever and 14% with abdominal tenderness.Diagnosis is based predominantly on abdominal computed tomography.The most frequent treatment was colic resection with en-bloc resection of the diverticulum,performed in 57.2% of cases,whereas Hartmann's procedure was followed in 11.4% of the cases and a diverticulectomy in 10.2%.An analysis of sixteen cases reported in the last 5 years showed that the majority of patients were treated with sigmoidectomy and en-bloc resection of the diverticulum; the postoperative mortality was null,morbidity was very low(1 patient was hospitalized in the intensive care unit for postoperative hypotension),and the patients were discharged 4-14 d after surgery.CONCLUSION: Giant colonic diverticulum is a rare manifestation of diverticular diseases.Surgical treatment,consisting predominantly of colonic resection with en bloc resection of the diverticulum,is thepreferred option for GCD and guarantees excellent results.
