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Amodu LI, Boyd BA, Smirnov V. Jejunal Diverticulosis Causing Small Intestinal Volvulus and Closed Loop Obstruction. Am J Case Rep 2024; 25:e943376. [PMID: 38693681 DOI: 10.12659/ajcr.943376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Jejunal diverticulosis are false diverticula of the small bowel that form from outpouching of the mucosa and submucosa. They are pulsion diverticula that are often asymptomatic and can be found incidentally during surgery. In some instances, jejunal diverticula could result in intestinal obstruction. Small intestinal volvulus is an uncommon cause of small bowel obstruction that results in a closed loop obstruction and is an indication for emergent surgical intervention. CASE REPORT We report a case of an 84-year-old man who presented to the Emergency Department with abdominal pain and generalized weakness. A preoperative computerized tomographic scan demonstrated a closed loop small bowel obstruction with mesenteric swirling. The patient was taken for a diagnostic laparoscopy, which revealed extensive proximal jejunal diverticulosis and a volvulus of the involved jejunum. An exploratory laparotomy was warranted for safe detorsion of the small bowel and resection of the diseased segment. The small bowel was successfully detorsed, with resection of the involved jejunum. Intestinal continuity was established by a primary side-to-side anastomosis. CONCLUSIONS Jejunal diverticula have been reported in the literature as a cause of small bowel obstructions, and very few reports exist of concurrent small bowel volvulus. In very rare instances, both of these conditions can coexist. There should be prompt surgical intervention in all cases of closed loop small bowel obstructions to prevent intestinal ischemia, perforation, and sepsis.
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Affiliation(s)
- Leo I Amodu
- Department of Surgery, New York University Langone Hospital, New York University Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Breana A Boyd
- Department of Surgery, New York University Langone Hospital, New York University Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Viktor Smirnov
- Department of Surgery, New York University Langone Hospital, New York University Grossman Long Island School of Medicine, Mineola, NY, USA
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Affiliation(s)
- Zongli Han
- Peking University Shenzhen Hospital, Shenzhen, China
| | - Yanli Du
- Shenzhen Polytechnic University, Shenzhen, China
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Mitsuishi A, Miura Y, Nomura Y, Hirota T, Arima N, Kitaoka H, Tateiwa H, Katsumata Y. Bleeding sites and treatment strategies for cardiac tamponade by catheter ablation requiring thoracotomy: risks of catheter ablation in patients with left atrial diverticulum. J Cardiothorac Surg 2024; 19:238. [PMID: 38632637 PMCID: PMC11022316 DOI: 10.1186/s13019-024-02710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There is insufficient information regarding the bleeding sites and surgical strategies of cardiac tamponade during catheter ablation for atrial fibrillation (AF). CASE PRESENTATION Of the five patients with cardiac tamponade, three required surgical intervention and two required pericardiocentesis. In the first case of three cardiac tamponades requiring surgical intervention, considering that the peripheral route was used, the catecholamines did not reach the heart, and due to unstable vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was inserted. No bleeding point was identified, but a thrombus had spread around the left atrium (LA) with diverticulum. Hemostasis was achieved with adhesives placed around the LA under on-pump beating. In the second case, pericardiocentesis was performed, but the patient showed heavy bleeding and unstable vital signs. Thus, VA-ECMO was inserted. Heavy bleeding was expected, and safety was enhanced by attaching a reservoir to the VA-ECMO. The bleeding point was found between the left upper pulmonary artery and LA under cardiac arrest to obtain a good surgical view for suturing repair. In the third case, the LA diverticulum was damaged. Pericardiocentesis resulted in stable vitals, but sustained bleeding was present. A bleeding point was found at the LA diverticulum, and suture repair under on-pump beating was performed. CONCLUSIONS When cardiac tamponade occured in any patient with LA diverticulum, treatment could not be completed with pericardiocentesis alone, and thoracotomy was likely to be necessary. If the bleeding point could be confirmed, suturing technique is a more reliable surgical strategy than adhesive alone that leads to pseudoaneurysm. If the bleeding point is unclear, it is important to confirm the occurrence of LA diverticulum using a preoperative CT, and if confirmed, cover it with adhesive due to a high possibility of diverticulum bleeding. The necessity of CPB should be determined based on whether these operations can be completed while maintaining vital stability.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan.
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Yoshinori Nomura
- Department of Clinical Engineering, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Naoki Arima
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Hiroki Tateiwa
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Yoshifumi Katsumata
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
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Spath P, Marazzi G, Stana J, Peterss S, Fernandez-Prendes C, Rantner B, Pichlmaier MA, Tsilimparis N. Endovascular Repair With Triple Inner-Branch Endograft for Aberrant Subclavian Artery Aneurysm: A Case Report. J Endovasc Ther 2024; 31:318-324. [PMID: 35941824 DOI: 10.1177/15266028221116753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endovascular repair of the thoracic aorta (TEVAR) is the preferred option for the treatment of the distal arch and descending thoracic aorta. Fenestrated and branched TEVAR have become an option to treat pathologies of the aortic arch, avoiding sternotomy and cardiopulmonary arrest as well as total surgical debranching. We describe here the case of a symptomatic patient with an arteria lusoria aneurysm associated with Kommerel diverticulum who underwent total endovascular repair with a triple-branched TEVAR. CASE REPORT A 66-year-old male patient was treated for a symptomatic arteria lusoria artery associated with a Kommerel diverticulum, resulting in difficulty swallowing and choking. We used a custom-made triple inner-branch endograft (Cook Medical, Bloomington, Indiana) following implantation of a right-sided carotid-subclavian (C-S) bypass. The C-S bypass occluded in the interval time between the 2 procedures and required recanalization and stent-graft placement during the aortic arch procedure. The arteria lusoria was embolized with a vascular plug. No complications occurred and postoperative tomography showed exclusion and thrombosis of the Kommerel diverticulum and perfusion of the supra-aortic vessels. CONCLUSIONS Treatment of arteria lusoria aneurysms can be performed with total endovascular arch inner-branch repair, avoiding increased risk of morbidity and mortality caused by open or hybrid procedures.
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Affiliation(s)
- Paolo Spath
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Giulia Marazzi
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
- Vascular Surgery, Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Jan Stana
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
| | | | - Barbara Rantner
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Nikolaos Tsilimparis
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
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Mukherjee D, Singh R, Weyant M, Paolucci B, Ryan L. A Novel Hybrid Approach to Management of KD: Role of Robotic Surgery. Vasc Endovascular Surg 2024; 58:414-418. [PMID: 37966457 DOI: 10.1177/15385744231215572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The management of Kommerell's Diverticulum (KD) has been evolving from open repair to a hybrid of open and endovascular repair. While there is no consensus regarding the optimal strategy, the need for less invasive treatment with less morbidity early recovery, and improved quality of life is a common goal for both the patient and the provider.
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Affiliation(s)
| | - Ramesh Singh
- Inova Fairfax Hospital, Inova Fairfax Hospital, VA, USA
| | | | | | - Liam Ryan
- Vascular Surgery, Inova Health System, Fairfax, VA, USA
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Zeng SP, Sun YF, Yu HY, Yang J, Deng KF. Efficacy of flexible ureterorenoscopy with holmium laser in the management of calyceal diverticular calculi. Urolithiasis 2024; 52:50. [PMID: 38554174 PMCID: PMC10981604 DOI: 10.1007/s00240-024-01552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/29/2024] [Indexed: 04/01/2024]
Abstract
The purpose of this study was to evaluate the efficacy and safety of flexible ureteroscopy with holmium laser lithotripsy in the management of calyceal diverticular calculi. In this study, we retrospectively analyzed the clinical data of 27 patients with calyceal diverticular calculi admitted to the Department of Urology of the Zigong First People's Hospital from May 2018 to May 2021. Intraoperatively, the diverticular neck was found in all 27 patients, but flexible ureterorenoscopy lithotripsy was not performed in 2 cases because of the slender diverticular neck, and the success rate of the operation was 92.6%. Of the 25 patients with successful lithotripsy, the mean operative time was 76.9 ± 35.5 (43-200) min. There were no serious intraoperative complications such as ureteral perforation, mucosal avulsion, or hemorrhage. Postoperative minor complications (Clavien classification I-II) occurred in 4 (16%) patients. The mean hospital stay was 4.4 ± 1.7 (3-12) days. The stone-free rate was 80% at the 1-month postoperative follow-up. After the second-stage treatment, the stone-free rate was 88%. In 22 cases with complete stone clearance, no stone recurrence was observed at 5.3 ± 2.6 (3-12) months follow-up. This retrospective study demonstrated that flexible ureterorenoscopy with holmium laser is a safe and effective choice for the treatment of calyceal diverticular calculi, because it utilizes the natural lumen of the human body and has the advantages of less trauma, fewer complications, and a higher stone-free rate.
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Affiliation(s)
- Shi-Ping Zeng
- Department of Urology, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Yi-Fei Sun
- Neurological Disease Laboratory, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Han-Yang Yu
- Department of Urology, The People's Hospital of Weiyuan, Neijiang, Sichuan, China
| | - Jian Yang
- Department of Urology, Zigong First People's Hospital, Zigong, Sichuan, China
| | - Ke-Fei Deng
- Department of Urology, Zigong First People's Hospital, Zigong, Sichuan, China.
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Rodríguez Jiménez J, Iglesias Sobrino C, García Solo de Zaldívar FJ, Pérez Hernández FA. Complicated giant colonic diverticulum: imaging-based diagnosis. Rev Esp Enferm Dig 2024; 116:161-162. [PMID: 36562530 DOI: 10.17235/reed.2022.9312/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A 66-year-old male from Venezuela with history of high blood pressure and diverticulosis is being studied on an outpatient basis for abdominal pain and weight loss of several months of evolution. He presented to the emergency department due to worsening abdominal pain in the last 48 hours and fever. His abdomen was mildly tender to palpation in the left hypochondrium but did not exhibit signs of peritonitis. An abdominal x-ray was performed, revealing an oval, smooth-walled mass located in the left upper quadrant that contained a gas-fluid level. An outpatient abdominal CT scan performed two months earlier showed an intraabdominal, 14.8x10x16cm air cystic lesion, proposing giant colonic diverticulum as first diagnostic possibility. Given the findings of the abdominal x-ray, urgent abdominal CT was requested (image 3) with results suggestive of sigmoid-dependent giant diverticulum, complicated by probable superinfection and torsion of the sigma at its base. Considering the suspected diagnosis, the patient underwent diverticulectomy, demonstrating purulent content inside. Histopathology confirmed the diagnosis. Evolution after surgery was favourable and the patient was discharged on the sixth postoperative day.
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Zheng K, Sa Y, Hao C, Li C, Li W, Miao F, Gu C, Ding X, Huang J, Zhang Q, Huang J, Song L, Huang J, Si J, Zhang K, Fu Q, Hu X. Modified Y-V plasty based on MRU evaluation for iatrogenic bladder outlet obliteration: a multicentre experience in China. World J Urol 2024; 42:88. [PMID: 38372802 DOI: 10.1007/s00345-023-04765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/26/2023] [Indexed: 02/20/2024] Open
Abstract
PURPOSE To compare the diagnostic ability of traditional radiographic urethrography and magnetic resonance urethrography (MRU) for iatrogenic bladder outlet obliteration (BOO), and explore the efficacy and complications of laparoscopic modified Y-V plasty for patients selected based on MRU evaluation. METHODS 31 patients with obliteration segments ≤ 2 cm and no false passages or diverticula based on MRU evaluation from eight centers in China were included. Obliteration segments were measured preoperatively by MRU and conventional RUG/VCUG and compared with intra-operative measurements. Surgical effects were evaluated by uroflow rates, urethrography, or cystoscopy at 1, 3, 6, and 12 months post-operation and then every 12 months. Postoperative urinary continence was assessed by 24-h urine leakage (g/day). RESULTS The results showed that MRU measured the length of obliteration more accurately than RUG/VCUG (MRU 0.91 ± 0.23 cm, RUG/VCUG 1.72 ± 1.08 cm, Actual length 0.96 ± 0.36 cm, p < 0.001), and clearly detected false passages and diverticula. Laparoscopic Y-V plasty was modified by incisions at 5 and 7 o'clock positions and double-layer suture with barbed sutures. All operations were successfully completed within a median time of 75 (62-192) minutes and without any complications. Urethral patency and urinary continence rates were 90.3% (28/31) and 87.1% (27/31), respectively. Three recurrences were cured by direct visual internal urethrotomy. Four patients had stress urinary incontinence after catheter removal 14 days post-operation, with urine leakage of 80-120 g/day, not relieved during follow-up. CONCLUSIONS Laparoscopic modified Y-V plasty based on MRU evaluation is a promising approach for iatrogenic BOO, with a high patency rate and a low incontinence rate.
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Affiliation(s)
- Kun Zheng
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Yinglong Sa
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Chuan Hao
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Chengyong Li
- Department of Urology, Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Wei Li
- Department of Urology, People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, 530016, Guangxi, China
| | - Fachen Miao
- Department of Urology, Shanxian Central Hospital, Heze, 274399, Shandong, China
| | - Chaohui Gu
- Department of Urology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaoju Ding
- Department of Urology, Guilin Medical College Affiliated Hospital, Guilin, 541001, Guangxi, China
| | - Jiefu Huang
- Department of Urology, Guilin Medical College Affiliated Hospital, Guilin, 541001, Guangxi, China
| | - Qingbing Zhang
- Department of Urology, Dong E Hospital, Liaocheng, 252200, Shandong, China
| | - Jianbing Huang
- Department of Urology, Chinese Medicine Hospital of Mayang Autonomous County of Miao Nationality, Huaihua, 419400, Hunan, China
| | - Lujie Song
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Jianwen Huang
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Jiemin Si
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Kaile Zhang
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Qiang Fu
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai, 200233, China.
| | - Xiaoyong Hu
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai Jiao Tong University, Shanghai, 200233, China.
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Takayanagi T. Potential arrhythmic substrate of atrial fibrillation at the left atrial diverticulum. Nagoya J Med Sci 2024; 86:142-148. [PMID: 38505725 PMCID: PMC10945233 DOI: 10.18999/nagjms.86.1.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/19/2023] [Indexed: 03/21/2024]
Abstract
Catheter ablation therapy for persistent atrial fibrillation (PeAF) is both difficult and has limited outcomes. The mechanisms underlying the development and persistence of atrial fibrillation (AF) are not fully understood; therefore, ablation strategies are diverse. A 45-year-old man was referred to our hospital for persistent atrial fibrillation to undergo radiofrequency catheter insertion (RFCA). In the first session we conducted pulmonary vein isolation and additional linear ablation, including that of the roof line and posterior inferior line (posterior box lesion) as the stepwise ablation. However, AF was recurred in six months, therefore he was readmitted for second session ablation preoperative 3D computed tomography (CT) scan for drug-refractory PeAF was performed. The additional isolation of the left superior pulmonary vein and potential drivers of AF by mapping wavefront propagation using multipolar catheters by CARTOFINDER (Biosense Webster, Inc, Diamond Bar, CA, USA) was conducted. However, AF did not terminate. Tomography revealed that the left atrial (LA) diverticulum (LAD) was found uniquely. Electrophysiological findings showed focal firing of the myocardial sleeve and LA diverticulum by an approach for defragmented potentials by re-visiting in interval confidence level (ICL) mode included in the electroanatomical mapping system (CARTO 3, Biosense Webster, Inc, Diamond Bar, CA, USA) and the ablation by encircling this site finally made AF terminate. The AF has not recurred for more than 12 months without the use of antiarrhythmic drugs. This case report suggests that additional ablation around substrates in LAD may be effective for treating refractory AF.
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Affiliation(s)
- Takehiko Takayanagi
- Department of Cardiovascular Medicine, General Hospital Minamiseikyo Hospital, Nagoya, Japan
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Hsieh YL, Gao X, Chen X, Wang S, Wang W. Resurfacing Dehiscence(s) Without Reducing Diverticulum Effectively Silences Pulsatile Tinnitus: Novel Surgical Techniques for Diverticulum and Intraoperative Microphone Monitoring. Otol Neurotol 2024; 45:154-162. [PMID: 38152047 DOI: 10.1097/mao.0000000000004075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To emphasize the surgical importance of addressing dehiscence over diverticulum in resolving pulsatile tinnitus (PT) in patients with sigmoid sinus wall anomalies (SSWAs) and investigate anatomical differences. STUDY DESIGN Retrospective data analysis. SETTING Multi-institutional tertiary university medical centers. PATIENTS Fifty participants (dehiscence/diverticulum, 29:21 cases) with SSWA-associated PT were included in the study. All 21 diverticulum participants underwent surgical intervention. INTERVENTIONS 1) Surgical intervention with novel techniques monitored by intraoperative microphone. 2) Radiologic and ophthalmologic imaging methods. MAIN OUTCOME MEASURES Quantitative and qualitative preoperative and postoperative alterations of PT and anatomical differences between dehiscence and diverticulum. RESULTS Addressing dehiscence overlying diverticulum and sigmoid sinus wall dehiscences significantly reduced visual analog score and Tinnitus Handicap Inventory ( p < 0.01). Sinus wall reconstruction led to substantial PT sound intensity reduction in the frequency range of 20 to 1000 Hz and 20 to 500 Hz (paired-sample t test, p < 0.01). Diploic vein analysis showed a significant positive correlation in 85.7% of the diverticulum cohort compared with the dehiscence cohort ( p < 0.01). Eight percent of the participants exhibited papilledema, which was limited to the dehiscence cohort. CONCLUSION 1) Effective reduction of PT can be achieved by addressing all dehiscences, including those overlying the diverticulum, without the need to exclude the diverticulum. 2) Diploic vein may involve in the formation of diverticulum, and loss of dura mater and vascular wall thickness are observed at the SSWA locations.
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Affiliation(s)
- Yue-Lin Hsieh
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University
| | - Xiuli Gao
- Department of Radiology, Eye & ENT Hospital, Fudan University
| | - Xi Chen
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shenjiang Wang
- Department of Radiology, Eye & ENT Hospital, Fudan University
| | - Wuqing Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University
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11
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Liang C, Zhang L, Yu J, Miao C. Complicated Airway Management Because of Multiple Tracheal Diverticula in a Patient with Mounier-Kuhn Syndrome. Anesthesiology 2024; 140:291-292. [PMID: 38063471 DOI: 10.1097/aln.0000000000004813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Chao Liang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Li Zhang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian Yu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
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12
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Griffeth EM, Stephens EH, Dearani JA, Francois C, Todd A, Miranda WR, Connolly HM, Bonnichsen CR, Pochettino A. Outcomes of Surgical Repair of Aberrant Subclavian Arteries in Adults. Ann Thorac Surg 2024; 117:396-402. [PMID: 37030428 PMCID: PMC10556195 DOI: 10.1016/j.athoracsur.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND Symptoms, imaging characteristics, and early and midterm surgical outcomes for aberrant subclavian arteries (ASCA) are not well defined in the adult population. METHODS A single-institution retrospective review was conducted of adults undergoing surgical repair of ASCA and descending aorta origin/Kommerell diverticulum (KD) from January 1, 2002, to December 31, 2021. Symptom improvement and differences in imaging characteristics between anatomic groups and the number of symptoms were assessed. RESULTS Mean age was 46 ± 17 years. There were 23 of 37 left aortic arches with right ASCA (62%) and 14 of 37 right aortic arches with left ASCA (38%). Of these, 31 of 37 (84%) were symptomatic, and 19 of 37 (51%) had KD size/growth meeting criteria for surgical repair. KD aortic origin diameter was larger in more symptomatic patients: 20.60 mm (interquartile range [IQR], 16.42-30.68 mm) in patients with ≥3 symptoms vs 22.05 mm (IQR, 17.52-24.21 mm) for 2 symptoms vs 13.72 mm (IQR, 12.70-15.95 mm) for 1 symptom (P = .018). Aortic replacement was required in 22 of 37 (59%). There were no early deaths. Complications occurred in 11 of 37 (30%): vocal cord dysfunction (4 of 37 [11%]), chylothorax (3 of 37 [8%]), Horner syndrome (2 of 37 [5%]), spinal deficit (2 of 37 [5%]), stroke (1 of 37 [3%]), and temporary dialysis requirement (1 of 37 [3%]). Over a median follow-up of 2.3 years (IQR, 0.8-3.9 years), there was 1 endovascular reintervention and no reoperations. Dysphagia and shortness of breath resolved in 92% and 89%, respectively, whereas gastroesophageal reflux persisted in 47%. CONCLUSIONS The KD aortic origin diameter correlates with the number of symptoms, and surgical repair of ASCA and descending aorta origin/KD effectively relieves symptoms, with low rates of reintervention. Given the operative complexity, surgical repair should be performed in patients meeting size criteria or with significant dysphagia or shortness of breath symptoms.
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Affiliation(s)
- Elaine M Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - William R Miranda
- Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Heidi M Connolly
- Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Crystal R Bonnichsen
- Division of Structural Heart Disease, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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13
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Bangeas P, Konstantinidis N, Chrisopoulou T, Karatzia D, Giakoustidis A, Papadopoulos VN. Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature. Medicina (Kaunas) 2024; 60:229. [PMID: 38399517 PMCID: PMC10890375 DOI: 10.3390/medicina60020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.
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Affiliation(s)
- Petros Bangeas
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
- Department of Radiology, Genesis General Clinic, 54301 Thessaloniki, Greece;
| | - Nikolaos Konstantinidis
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Tania Chrisopoulou
- Department of Radiology, Genesis General Clinic, 54301 Thessaloniki, Greece;
| | - Despoina Karatzia
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Alexandros Giakoustidis
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
| | - Vasileios N. Papadopoulos
- 1st University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (N.K.); (D.K.); (A.G.); (V.N.P.)
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14
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Wang Y, Li S, Jin M, Xue Y, Wang D, Zhou Q. Surgical treatment for right-side aortic arch concomitant with Kommerell's diverticulum: techniques selection and follow-up results. Eur J Med Res 2024; 29:10. [PMID: 38172972 PMCID: PMC10762982 DOI: 10.1186/s40001-023-01595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Right-side aortic arch concomitant with Kommerell's diverticulum (KD) is a rare and complex ailment, and there is no consensus on the optimal strategy to deal with this congenital anomaly. We retrospectively analyzed and summary of the cases treated in our center with individual treatment methods for different situations. METHODS Between September 2018 and December 2021, 10 patients experienced surgical therapy at our institution who presented with a Kommerell's diverticulum arising from an aberrant subclavian artery from the right-side aortic arch. Four main surgical techniques were applied to those patients: 1. total arch replacement with frozen elephant trunk implantation (n = 2); 2. hybrid procedure combining open arch repair and endovascular intervention (n = 1); 3. total endovascular repair using thoracic endovascular aortic repair (TEVAR) with or without left subclavian artery (LSCA) revascularization (n = 6); 4. direct repair underwent endoaneurysmorrhaphy. Clinical characteristics and outcomes were collected. RESULTS The mean age of these 10 patients was 56.5 years (range 29-79 years) and only 1 woman. The pathology includes aortic dissection (n = 6) and aneurysm (n = 4). The mean diverticulum size was 41.4 [24.2-56.8] mm. There were no in-hospital deaths, and the median hospital stay was 22 [15-43] days. During the follow-up period (21.4 months, 1-44 months), one died of an unknown cause and one died of esophageal fistula. Two patients underwent second-stage endovascular intervention for distal lesion. And none of the patients had endoleak during the follow-up period. CONCLUSIONS Each of the procedures we have mentioned here has its advantages and disadvantages; individualized treatment should meet the appropriate indications. A single-branched stent graft is feasible and effective in the treatment of aortic disease combined with Kommerell's diverticulum.
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Affiliation(s)
- Yali Wang
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Shuchun Li
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Min Jin
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Yunxing Xue
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Dongjin Wang
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
| | - Qing Zhou
- Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China.
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15
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Cheong D, Jhaveri S, Smerling J, Rajagopal H, Misra N, Meyer DB. Association and Repair of Right Aortic Arch With Aberrant Left Subclavian Artery With Subclavian Stenosis. World J Pediatr Congenit Heart Surg 2024; 15:133-136. [PMID: 37728165 DOI: 10.1177/21501351231194256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Surgical repair of right aortic arch and aberrant left subclavian artery has traditionally involved ligamentum division. Such patients can have stenosis at the origin of the aberrant subclavian artery either at the time of presentation or later. The more recently popularized repair involving resection of Kommerell diverticulum with transfer of the subclavian artery to the left carotid artery allows resection of the stenotic segment and serves as an effective treatment for subclavian stenosis as well. We present three cases of early repair of this arch anomaly with associated subclavian stenosis repaired successfully in that manner.
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Affiliation(s)
- Daniel Cheong
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Simone Jhaveri
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Jonathan Smerling
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Hari Rajagopal
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Nilanjana Misra
- Division of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - David B Meyer
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
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16
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Suthar PP, Dua SG. Intraventricular membrane with ventricular diverticulum. J Postgrad Med 2024; 70:64-65. [PMID: 37530375 PMCID: PMC10947728 DOI: 10.4103/jpgm.jpgm_119_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- PP Suthar
- Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL, USA
| | - SG Dua
- Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL, USA
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17
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Tanisaka Y, Mizuide M, Ryozawa S. Texture and color enhancement imaging aided in the identification of a deviated bile duct orifice in a patient with a large periampullary diverticulum. J Hepatobiliary Pancreat Sci 2024; 31:e3-e4. [PMID: 37799002 DOI: 10.1002/jhbp.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 10/07/2023]
Abstract
Deviation of the bile duct orifice due to a large periampullary diverticulum presents difficulty in identifying the bile duct orifice, resulting in failure to achieve selective biliary cannulation. Tanisaka and colleagues demonstrate the usefulness of texture and color enhancement imaging for the identification of a deviated bile duct orifice.
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Affiliation(s)
- Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan
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18
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Zhang S, Wu Z, Chen M, Li X, Liu Q, Zhou S. Comparison between conventional approach and three-dimensional mapping system in the catheter ablation of accessory pathway associated with coronary sinus diverticulum: A single-center experience. Ann Noninvasive Electrocardiol 2024; 29:e13100. [PMID: 38115789 PMCID: PMC10770808 DOI: 10.1111/anec.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/28/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Posteroseptal accessory pathways (APs) associated with coronary sinus (CS) diverticulum present a rare and challenge for ablation. This study aimed to compare the safety and efficacy of conventional approach and three-dimensional (3D) mapping system in the catheter ablation. METHODS AND RESULTS This was a retrospective study of all patients (from January 2013 to July 2022) who underwent catheter ablation of posteroseptal AP associated with CS diverticula in our center. Patients who underwent catheter ablation using the traditional fluoroscopy method were included in the conventional method group (n = 13). Patients who underwent catheter ablation using the 3D mapping method were included in the 3D mapping group (n = 11). Clinical characteristics, ablation procedure, and outcomes were recorded and analyzed between the two groups. Out of 669 patients with posteroseptal APs, 24 of them (3.6%) were associated with CS diverticula. All patients in both groups successfully completed the electrophysiological study. In the conventional method group, two patients experienced complications (one patient with pericardial effusion and the other patient with femoral arterial hematoma), and two patients had recurrence. However, no patients suffered from complications or recurrence during follow-up. The procedure time and fluoroscopy time in the conventional method group were significantly longer than those in the 3D mapping method group. CONCLUSIONS The utilization of 3D mapping led to reduced fluoroscopy time, shorter procedure duration, enhanced acute success rates, and decreased incidence of complications.
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Affiliation(s)
- Shuang Zhang
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Zhihong Wu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Mingxian Chen
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Xuping Li
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Qiming Liu
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
| | - Shenghua Zhou
- Department of CardiologyThe Second Xiangya Hospital of Central South UniversityChangshaChina
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19
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Suzuki H, Fujishiro A, Arai T. Successful One-Lung Ventilation With a Double Bronchial Blocker Technique in a Patient With Bronchial Anomaly and Tracheal Stenosis Caused by Kommerell Diverticulum. J Cardiothorac Vasc Anesth 2023; 37:2607-2610. [PMID: 37798241 DOI: 10.1053/j.jvca.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Hiroaki Suzuki
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan.
| | - Asuka Fujishiro
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
| | - Takero Arai
- Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, Koshigaya City, Japan
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20
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Tanabe H, Kawano K, Kawano R, Katoh T, Nishi K, Komeda Y, Takenaka M. Hemostasis of small-intestinal diverticular bleeding with the over-the-scope clip method. Endoscopy 2023; 55:E1001-E1002. [PMID: 37604452 PMCID: PMC10442216 DOI: 10.1055/a-2098-8596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Hiroshi Tanabe
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Koichiro Kawano
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Reiko Kawano
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Takao Katoh
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Katsuhisa Nishi
- Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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21
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Capasso M, Dioscoridi L, Forti E, Pugliese F, Cintolo M, Bonato G, Mutignani M. Totally endoscopic treatment of duodenal diverticulum. Endoscopy 2023; 55:E1051-E1052. [PMID: 37714211 PMCID: PMC10504031 DOI: 10.1055/a-2155-4535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Affiliation(s)
- Mario Capasso
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
| | - Giulia Bonato
- Digestive and Interventional Endoscopy Unit, ASST Niguarda Hospital, Milan, Italy
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22
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Liu XL, Tian H. A Duodenal Diverticulum Causing Obstructive Jaundice in a 68-Year-Old Man. Dig Dis Sci 2023; 68:4277-4278. [PMID: 37794294 DOI: 10.1007/s10620-023-08037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Xin-Liang Liu
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Hu Tian
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, 250014, Shandong, China.
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23
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Tao C, Cao Y, Mao C. Surgical removal of primary bladder diverticulum in children under pneumovesicum laparoscopy. Asian J Surg 2023; 46:5521-5522. [PMID: 37541892 DOI: 10.1016/j.asjsur.2023.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Chengpin Tao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
| | - Yongsheng Cao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Changkun Mao
- Department of Urology, Anhui Provincial Children's Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
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24
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Narula N, Gibbs KE, Kong F, Mukherjee I. Appendiceal Intussusception, Diverticula, and Fecalith Associated With Appendicitis. Am Surg 2023; 89:6257-6259. [PMID: 36074037 DOI: 10.1177/00031348221126954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nisha Narula
- Department of Surgery, Staten Island University Hospital
| | - Karen E Gibbs
- Department of Surgery, Yale New Haven Health, Bridgeport, CT, USA
| | - Fanyi Kong
- Department of Pathology, Staten Island University Hospital, Staten Island, NY, USA
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25
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Chiew SF, Toh YF, Looi LM, Cheah PL. Gastrointestinal stromal tumour in a jejunal diverticulum: The eighth reported case worldwide with a brief review of the literature. Malays J Pathol 2023; 45:473-478. [PMID: 38155388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Jejunal diverticulosis is uncommon and so are gastrointestinal stromal tumours (GIST) arising in the jejunum. GIST arising in a jejunal diverticulum is a rarity and to date there are only 7 cases in the English literature. Our case of GIST occurring in a jejunal diverticulum of a 48-year-old lady would be the first reported in Malaysia and the 8th in the world. As in most cases, the clinical presentation and radiological findings of this patient were non-specific. With a history of acute abdominal pain, vomiting and fever, the patient was provisionally diagnosed as a case of twisted ovarian cyst and subjected to laparotomy. An intact roundish jejunal diverticulum 5.0 cm x 5.0 cm, about 50 cm distal to the duodeno-jejunal junction was found and resected with a segment of small intestine. Microscopic examination showed a tumour of the cut open diverticular wall, with epithelioid to spindled cells, demonstrating a mitotic rate of 1-2 per 5 mm2, confined to, while infiltrating the wall of the diverticulum. The immunohistochemical profile of positive staining for CD117, DOG-1, smooth muscle actin and CD34, and negative expression of desmin and S100 protein, clinched the diagnosis of GIST. Based on the AFIP Criteria for risk stratification,1 the patient was categorised as having moderate risk for disease progression, and was not offered further targeted imatinib as an immediate measure. The patient has remained well at the time of writing i.e. 8 months following excision, and continues on active surveillance by the surgical and oncological teams, with the option of imatinib, should the necessity arise. This case is presented not merely for the sake of documenting its rarity, but as a reminder to stay alert for uncommon conditions in histopathology practice.
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Affiliation(s)
- S F Chiew
- University of Malaya Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia.
| | - Y F Toh
- University of Malaya, Department of Pathology, Kuala Lumpur, Malaysia
| | - L M Looi
- University of Malaya, Department of Pathology, Kuala Lumpur, Malaysia
| | - P L Cheah
- University of Malaya, Department of Pathology, Kuala Lumpur, Malaysia
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26
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Ye S, Feng W, Zhou Y, Ming A, Chen M, Yang C, Zheng C, Gao R, Diao M, Wang Y, Li L. Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty. Medicine (Baltimore) 2023; 102:e35825. [PMID: 37986398 PMCID: PMC10659725 DOI: 10.1097/md.0000000000035825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/22/2023] Open
Abstract
Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016-2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.
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Affiliation(s)
- Shiru Ye
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
| | - Wei Feng
- Department of General & Neonatal Surgery, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yan Zhou
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
| | - Anxiao Ming
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
| | - Minming Chen
- Department of General & Neonatal Surgery, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Changzhen Yang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Zheng
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
| | - Ruyue Gao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Wang
- Department of General & Neonatal Surgery, Children’s Hospital of Chongqing Medical University; National Clinical Research Center for Child Health and Disorders; Ministry of Education Key Laboratory of Child Development and Disorders; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment(2021RU015), Chinese Academy of Medical Sciences, Beijing, China
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Yabu N, Minami T, Izubuchi R, Kojima T, Yamazaki I. Total arch replacement with frozen elephant trunk technique for Kommerell's diverticulum with a right-sided aortic arch and aberrant left subclavian artery. J Cardiothorac Surg 2023; 18:317. [PMID: 37950295 PMCID: PMC10638817 DOI: 10.1186/s13019-023-02425-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Kommerell's diverticulum with a right-sided aortic arch and aberrant left subclavian artery is uncommon. We perforemed a single-stage procedure with the frozen elephant trunk technique. CASE PRESENTATION A 62-year-old man underwent aortic dissection a year ago, and computerized tomographic angiography performed at that time revealed a right aortic arch, Kommerell's diverticulum (42 mm), and an aberrant left subclavian artery. We performed one-stage repair through median sternotomy. The cervical branches were exposed during the operation, and a deep hypothermic circulatory arrest with antegrade cerebral perfusion was established. The aorta was transected distally to the origin of the left carotid artery. We inserted a stent graft into the aorta, followed by peripheral anastomosis using a premade 5-branch Dacron graft. The right subclavian artery and the aorta were reconstructed, and the remaining cervical branches were reconstructed after the cross-clamp had been released. CONCLUSIONS Total arch replacement through median sternotomy was performed for the right aortic arch, Kommerell's diverticulum, and aberrant left subclavian artery. The frozen elephant trunk technique is allowed to perform a one-stage operation safely.
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Affiliation(s)
- Naoto Yabu
- Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa 2-6-1, Fujisawa, Kanagawa, 251-8550, Japan.
| | - Tomoyuki Minami
- Department of Surgery, Yokohama City University, Fukuura 3-9, Kanazawa-ku, Yokohama, Kanagawa, 236-004, Japan
| | - Ryo Izubuchi
- Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa 2-6-1, Fujisawa, Kanagawa, 251-8550, Japan
| | - Takahiro Kojima
- Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa 2-6-1, Fujisawa, Kanagawa, 251-8550, Japan
| | - Ichiya Yamazaki
- Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa 2-6-1, Fujisawa, Kanagawa, 251-8550, Japan
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Solano A, Pizano A, Azam J, Gonzalez-Guardiola G, Siah M, Chamseddin K, Prakash V, Kirkwood ML, Shih M. Kommerell's Diverticulum in a Right-Sided Aortic Arch With an Aberrant Left Subclavian Artery Hybrid Repair. Vasc Endovascular Surg 2023; 57:954-959. [PMID: 37310394 PMCID: PMC10543133 DOI: 10.1177/15385744231183310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Kommerell's diverticulum (KD) with a right aortic arch (RAA) and aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the aortic arch. Treatment is not well defined due to its uncommon presentation, with rupture and dissection risk rates of up to 53%. CASE SUMMARY A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presented with difficulty breathing during exercise without dysphagia. Follow-up computerized tomography angiogram (CTA) revealed the presence of a RAA and aLSCA arising from the descending thoracic aorta with an adjacent 58 × 41-mm KD and tracheal and esophageal displacement. Due to the size of the KD, risk of rupture, unsuitable anatomy for total endovascular aortic repair (EVAR), and high COPD burden, the patient was planned to undergo a hybrid surgical repair. Left common carotid (LCCA) artery to LSCA bypass, full aortic debranching, LSCA embolization and percutaneous thoracic endovascular aortic repair (TEVAR) were performed. Successful device position and exclusion of the diverticulum and aneurysmal aorta were observed after completion thoracic aortogram. 18-month follow-up CTA demonstrated patency of the LSCA to LCCA bypass graft and arch vessel branches, as well as stable exclusion of the KD. Persistence of a type II endoleak originated at the right first posterior intercostal artery has been noted and is being followed conservatively since no sac growth has occurred. CONCLUSION We highlight the presence of a KD with RAA and aberrant subclavian artery, a rare congenital anatomic variation of the aortic arch with complex anatomy. Surgical planning must be individualized according to comorbidities and anatomical variations identified on imaging and 3D reconstructions.
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Affiliation(s)
- Antonio Solano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Alejandro Pizano
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Jawaher Azam
- Medical School, University of Texas Southwestern Medical Center, Dallas, TX, USA Presented at the poster session of the Critical Issues America Annual Meeting. Miami, FL, February 10-11, 2023
| | - Gerardo Gonzalez-Guardiola
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Michael Siah
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Khalil Chamseddin
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Vivek Prakash
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Melissa L. Kirkwood
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas, Dallas, TX, USA
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Sharma A, Biswal D, Sharma S, Roy S. An elderly male with lower urinary tract symptoms during COVID-19 pandemic: Extraperitoneal perforation of bladder diverticulum. Urologia 2023; 90:763-765. [PMID: 34082626 DOI: 10.1177/03915603211022945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CASE We present a case of spontaneous extra-peritoneal rupture of an acquired diverticulum an elderly male with symptoms of bladder outlet obstruction who presented in emergency with acute abdomen. OUTCOME The acute phase was managed conservatively with bladder drainage and intravenous antibiotics. He recently underwent Transurethral Resection of Prostate. He is asymptomatic on follow-up. CONCLUSIONS Acquired bladder diverticulum are rare in adults and are mostly seen in patients with high pressure bladder due to bladder outlet obstruction. Atraumatic extraperitoneal ruptures of diverticulum are uncommonly reported.
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Affiliation(s)
- Amit Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Deepak Biswal
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Satyadeo Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Siddhant Roy
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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30
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Zimmer V. A 'windsock' diverticulum. ANZ J Surg 2023; 93:2757. [PMID: 37443406 DOI: 10.1111/ans.18596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Vincent Zimmer
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
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Torun EG, Koca S, Dinçel GK, Çay S. Successful catheter ablation of the accessory pathway in an unusual location in a 13-year-old girl with a coronary sinus diverticulum and Wolff-Parkinson-White syndrome. Cardiol Young 2023; 33:2375-2378. [PMID: 37144400 DOI: 10.1017/s1047951123001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Wolff-Parkinson-White syndrome is a congenital cardiac pre-excitation syndrome that is effectively treated by ablating the accessory pathway. However, accessory pathways located in the posteroseptal region can sometimes be challenging. In this paper, we present the successful ablation of the epicardial posteroseptal accessory pathway through the middle cardiac vein in a 13-year-old girl with a coronary sinus diverticulum and Wolff-Parkinson-White syndrome, after unsuccessful ablation attempts at different locations. If the ablation procedure fails, the possibility of the posteroseptal pathway should be kept in mind, and coronary sinus angiography should be performed. In cases with a coronary sinus diverticulum where ablation is not successful, other coronary sinus structures, for example, the middle cardiac vein should be considered as potential accessory pathways.
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Affiliation(s)
- Emine Gulsah Torun
- Department of Pediatric Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Serhat Koca
- Department of Pediatric Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Gökçe Kaya Dinçel
- Department of Pediatric Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Serkan Çay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, Ankara City Hospital, Ankara, Turkey
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Toyonaga H, Hayashi T, Hama K, Iwano K, Ando R, Ishii T, Kin T, Motoya M, Takahashi K, Katanuma A. Tip-in endoscopic papillectomy for ampullary adenoma near diverticulum to minimize complications. J Hepatobiliary Pancreat Sci 2023; 30:e75-e77. [PMID: 37776049 DOI: 10.1002/jhbp.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 10/01/2023]
Abstract
Toyonaga and colleagues present a novel "tip-in endoscopic papillectomy" approach for resecting ampullary tumors, aiming to minimize complications like perforation and residual tumor by adapting the colonic polyp endoscopic mucosal resection tip-in method. The technique is described with accompanying video in a case of ampullary tumor near a diverticulum.
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Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kazuki Hama
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kosuke Iwano
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ryo Ando
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tatsuya Ishii
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Masayo Motoya
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
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Lachkar S, Ibrahimi A, Boualaoui I, El Sayegh H, Nouini Y. [Thirty-nine cases of suburethral diverticula in women: 30 years single center experience]. Pan Afr Med J 2023; 46:51. [PMID: 38223879 PMCID: PMC10787138 DOI: 10.11604/pamj.2023.46.51.41246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/23/2023] [Indexed: 01/16/2024] Open
Abstract
We here report a retrospective analysis of 30 years´ experience with 39 female patients suffering from suburethral diverticula. The average age of patients was 37 years of age (24-56 years). The average parity was 2 (1-7); 65% of deliveries were complicated by dystocia, with forceps used in 43% of cases. All patients had a history of urological or gynaecological infections. The revealing symptoms were heterogeneous but recurrent urinary tract infections (26 cases), pollakiuria (23 cases), post-micturition urethral discharge (21 cases), vaginal pain (17 cases) and a sensation of vaginal bulge (15 cases) were mostly reported. Radiological assessment were performed, including intravenous urography, retrograde and micturition urethrography, ultrasound, or MRI. Transvaginal diverticulectomy was the treatment of choice for all patients, with no reported intraoperative complications. At 4 years of follow up outcome was satisfactory. Four patients developed recurrence of diverticulitis. These data provide important information about clinical features, diagnostic results and long-term outcomes of transvaginal diverticulectomy, enabling better management of this rare condition.
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Affiliation(s)
- Salim Lachkar
- Service d’Urologie A, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc
| | - Ahmed Ibrahimi
- Service d’Urologie A, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc
| | - Imad Boualaoui
- Service d’Urologie A, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc
| | - Hachem El Sayegh
- Service d’Urologie A, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc
| | - Yassine Nouini
- Service d’Urologie A, Centre Hospitalier Universitaire Ibn Sina, Rabat, Maroc
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Wang Y, Hao X, Chen Y, Wang L, Zhou Y, Xue M, Dong Y, Sun L. Treatment of uterine scar cystoid diverticulum by hysteroscopy combined with laparoscopy. Fertil Steril 2023; 120:922-924. [PMID: 37499779 DOI: 10.1016/j.fertnstert.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To report a patient with prolonged intermenstrual bleeding and a cystic mass at a cesarean scar treated with laparoscopic folding sutures and hysteroscopic canalization. DESIGN A 4.0 cm-cystic mass formed at the uterine scar caused continuous menstrual blood outflow in the diverticulum and was treated with hysteroscopy combined with laparoscopy. SETTING University hospital. PATIENTS A 38-year-old woman of childbearing age who had undergone two cesarean sections and two abortions reported vaginal bleeding for 10 years, which began shortly after the second cesarean section. Curettage was performed, but no abnormality was found. The patient unsuccessfully tried to manage her symptoms with traditional Chinese medicine and hormone drugs. The muscular layer of the lower end of the anterior wall of the uterus was weak, and there were cystic masses on the right side. INTERVENTION The bladder was stripped from the lower uterine segment under laparoscopy, and the surrounding tissue of the mass at the uterine scar was separated. The position of the cesarean scar defect was identified by hysteroscopy combined with laparoscopy, and the relationship between the uterine mass and surrounding tissues was analyzed. An electric cutting ring resection on both sides of the obstruction was performed to eliminate the valve effect. The active intima of the scar diverticulum was destroyed by electrocoagulation, followed by laparoscopic treatment of the uterine scar diverticulum mass. An intraoperative tumor incision revealed visible bloody fluid mixed with intimal material. The uterine scar diverticulum defect was repaired using 1-0 absorbable barbed continuous full-thickness mattress fold sutures. Finally, the bilateral round ligament length was adjusted so that the uterus tilted forward. MAIN OUTCOME MEASURES Recovery of menstruation and anatomy of the uterine isthmus. RESULTS The operation was successful, and the postoperative recovery was fast. There was no interphase bleeding at the 1-month follow-up, and the uterine scar diverticulum was repaired, with the thickness of the uterine scar muscle layer increasing to 0.91 cm. CONCLUSION The simple, straightforward procedure to resolve the abnormal cystic, solid mass formed because of the continuous deposition of blood in the uterine scar diverticulum involved laparoscopic folding and docking sutures combined with hysteroscopic canal opening.
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Affiliation(s)
- Yanan Wang
- Departments of Gynecology and Obstetrics, Clinical Medical College of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Xianhua Hao
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Yahui Chen
- Departments of Gynecology and Obstetrics, Clinical Medical College of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Lin Wang
- Departments of Gynecology and Obstetrics, Clinical Medical College of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Yan Zhou
- Departments of Gynecology and Obstetrics, Clinical Medical College of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Mei Xue
- Departments of Gynecology and Obstetrics, Clinical Medical College of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Yan Dong
- Departments of Gynecology and Obstetrics, Clinical Medical College of Jining Medical University, Jining, Shandong, People's Republic of China; Department of Obstetrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China
| | - Lin Sun
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining, Shandong, People's Republic of China.
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Alotaibi FZ, Lee GD, Lee YS. Concurrent Killian-Jamieson and Zenker's Diverticula. J Craniofac Surg 2023; 34:e630-e632. [PMID: 37357348 PMCID: PMC10521795 DOI: 10.1097/scs.0000000000009434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/11/2023] [Indexed: 06/27/2023] Open
Abstract
Pharyngoesophageal diverticula are rare causes of dysphagia. Zenker's diverticulum is the most common type, followed by Killian-Jamieson diverticulum. A 44-year-old male presented to our clinic with a longstanding history of dysphagia and globus sensation. Bilateral pharyngoesophageal diverticula were confirmed by imaging CT and esophagogastroscopy. He underwent transcervical resection, and a right Killian-Jamieson diverticulum was observed during surgery. The left diverticulum was found to originate above the cricopharyngeus muscle and was labeled as Zenker's diverticulum. Bilateral pharyngoesophageal diverticula are rare, and physicians should be aware of the variable clinical presentations and management options for pharyngoesophageal diverticula.
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Affiliation(s)
- Fahad Zarraq Alotaibi
- Department of Otolaryngology-Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Geun-Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Liao C, He Z, Wang X, Guo P, Xiong W. Laparoscopic surgery for female posterior urethral bladder diverticulum with bladder outlet obstruction: A case report. Medicine (Baltimore) 2023; 102:e34971. [PMID: 37657035 PMCID: PMC10476744 DOI: 10.1097/md.0000000000034971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/07/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION Bladder diverticula (BD) can be classified into congenital and acquired forms, with the latter accounting for approximately 90% of all cases, primarily among male patients. Although BD-associated anatomical bladder outlet obstruction (BOO) is uncommon, existing literature suggests that congenital BD are more frequently observed in male children and rarely in female children. While around 70% of acquired BD are linked to BOO secondary to benign prostatic hyperplasia in male patients, clinical reports of female BD are less common. Furthermore, cases of female BD located posterior to the urethra, which lead to voiding difficulties, are exceedingly rare. CASE PRESENTATION Herein, we present a case of laparoscopic treatment in a 53-year-old female patient diagnosed with congenital bladder diverticulum causing progressively worsening dysuria. Voiding cystourethrography revealed a soft cystic protrusion of the posterior urethral wall during voiding, which reinforced the patient's symptoms. Urodynamic examination showed elevated detrusor muscle contraction during voiding, a reduced urinary flow rate, and P/Q values indicative of significant BOO. Considering the patient's clinical condition, we performed laparoscopic bladder diverticulectomy, partial urethral croppingplasty, and cystoplasty. RESULTS The laparoscopic bladder diverticulectomy, partial urethral croppingplasty, and cystoplasty procedures were completed thoroughly and with great success. However, complete removal of the diverticular epithelium proved challenging, resulting in an overall operative time of approximately 3 hours and 32 minutes. At the postoperative follow-up, the patient presented with symptoms of a lower urinary tract infection for a week, which were effectively resolved with oral antibiotics. At the 8-month follow-up, the patient reported normal urination and the absence of any discomfort during urination. CONCLUSION Female bladder outlet obstruction resulting from posterior urethral BD can be challenging to visualize during transurethral cystoscopy, especially with limited angulation, and may even be overlooked. Furthermore, conventional transvaginal diverticulectomy is often difficult to perform effectively. Therefore, laparoscopic bladder diverticulectomy, partial urethral croppingplasty, and cystoplasty are considered appropriate treatment options for such cases.
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Affiliation(s)
- Chongzhou Liao
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Urology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Zhenqiang He
- Department of Urology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoxiao Wang
- Department of Urology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Pu Guo
- Department of Urology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Wei Xiong
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Urology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
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37
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Moffatt C, Bath J, Rogers RT, Colglazier JJ, Braet DJ, Coleman DM, Scali ST, Back MR, Magee GA, Plotkin A, Dueppers P, Zimmermann A, Afifi RO, Khan S, Zarkowsky D, Dyba G, Soult MC, Mani K, Wanhainen A, Setacci C, Lenti M, Kabbani LS, Weaver MR, Bissacco D, Trimarchi S, Stoecker JB, Wang GJ, Szeberin Z, Pomozi E, Gelabert HA, Tish S, Hoel AW, Cortolillo NS, Spangler EL, Passman MA, De Caridi G, Benedetto F, Zhou W, Abuhakmeh Y, Newton DH, Liu CM, Tinelli G, Tshomba Y, Katoh A, Siada SS, Khashram M, Gormley S, Mullins JR, Schmittling ZC, Maldonado TS, Politano AD, Rynio P, Kazimierczak A, Gombert A, Jalaie H, Spath P, Gallitto E, Czerny M, Berger T, Davies MG, Stilo F, Montelione N, Mezzetto L, Veraldi GF, D'Oria M, Lepidi S, Lawrence P, Woo K. International Multi-Institutional Experience with Presentation and Management of Aortic Arch Laterality in Aberrant Subclavian Artery and Kommerell's Diverticulum. Ann Vasc Surg 2023; 95:23-31. [PMID: 37236537 DOI: 10.1016/j.avsg.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch. METHODS Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions. RESULTS 288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change. CONCLUSIONS In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality.
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Affiliation(s)
- Clare Moffatt
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Jonathan Bath
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Richard T Rogers
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN
| | - Drew J Braet
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Dawn M Coleman
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Salvatore T Scali
- Division of Vascular and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Martin R Back
- Division of Vascular and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
| | - Gregory A Magee
- Division of Vascular and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Anastasia Plotkin
- Division of Vascular and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Philip Dueppers
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Rana O Afifi
- Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Sophia Khan
- Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Devin Zarkowsky
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Gregory Dyba
- Division of Vascular Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO
| | - Michael C Soult
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Carlo Setacci
- Division of Vascular and Endovascular Surgery, Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Massimo Lenti
- Division of Vascular and Endovascular Surgery, Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Loay S Kabbani
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI
| | - Mitchell R Weaver
- Division of Vascular Surgery, Department of Surgery, Henry Ford Hospital, Detroit, MI
| | - Daniele Bissacco
- Department of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Santi Trimarchi
- Department of Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Jordan B Stoecker
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Eniko Pomozi
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Hugh A Gelabert
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shahed Tish
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Andrew W Hoel
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nicholas S Cortolillo
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily L Spangler
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Marc A Passman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Giovanni De Caridi
- Division of Vascular Surgery, Department of Medical Sciences and Morpho-Functional-Imaging, University of Messina, Messina, Italy
| | - Filippo Benedetto
- Division of Vascular Surgery, Department of Medical Sciences and Morpho-Functional-Imaging, University of Messina, Messina, Italy
| | - Wei Zhou
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Yousef Abuhakmeh
- Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, AZ
| | - Daniel H Newton
- Division of Vascular Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Christopher M Liu
- Division of Vascular Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Airi Katoh
- Department of Surgery, University of California San Francisco at Fresno, Fresno, CA
| | - Sammy S Siada
- Department of Surgery, University of California San Francisco at Fresno, Fresno, CA
| | - Manar Khashram
- Department of Surgery, University of Auckland, Waikato, New Zealand
| | - Sinead Gormley
- Department of Surgery, University of Auckland, Waikato, New Zealand
| | - John R Mullins
- Division of Vascular Surgery, Department of Surgery, CoxHealth, Springfield, MO
| | | | - Thomas S Maldonado
- Division of Vascular Surgery, Department of Surgery, New York University Langone Health, New York, NY
| | - Amani D Politano
- Division of Vascular Surgery, Department of Surgery, Oregon Health and Sciences University, Portland, OR
| | - Pawel Rynio
- Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
| | | | - Alexander Gombert
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Houman Jalaie
- Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Paolo Spath
- Department of Vascular Surgery, University of Bologna, DIMES, Bologna, Italy
| | - Enrico Gallitto
- Department of Vascular Surgery, University of Bologna, DIMES, Bologna, Italy
| | - Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Clinic for Cardiovascular Surgery, University Clinic Freiburg, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Tim Berger
- University Heart Center Freiburg-Bad Krozingen, Clinic for Cardiovascular Surgery, University Clinic Freiburg, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Mark G Davies
- Division of Vascular and Endovascular Surgery, Long School of Medicine, UT Health San Antonio, San Antonio, TX
| | - Francesco Stilo
- Operative Research Unit of Vascular Surgery, Department of Medicine and Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Nunzio Montelione
- Operative Research Unit of Vascular Surgery, Department of Medicine and Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - Luca Mezzetto
- Division of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Gian Franco Veraldi
- Division of Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular Surgery, University of Missouri, Columbia, MO
| | - Peter Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Karen Woo
- Division of Vascular and Endovascular Surgery, Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
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de Armas-Conde M, Hernández-Alonso R, Concepción-Martín V, Abellán-Fernández J, Padilla-Quintana J, Menéndez-Moreno A, Martínez-Blanco LI, Barrera-Gómez MÁ. Giant sigmoid diverticulum. Rev Esp Enferm Dig 2023; 115:536-537. [PMID: 37539515 DOI: 10.17235/reed.2023.9804/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Unlike acute diverticulitis, giant diverticulum larger than 4 cm is a rare entity with few cases described in the literature. We present a case of a 66-year-old male patient diagnosed with colonic diverticulosis. He presented to the emergency department with symptoms of acute abdomen and was diagnosed by CT scan with a 13x14 cm giant diverticulum showing signs of complication. Given the findings, an urgent surgical intervention was decided, and diverticulectomy at the diverticular neck was performed using an endostapler. The etiology of giant diverticula is related to a mechanism of one-way valve at the diverticular neck. Diagnosis poses a challenge as the clinical presentation is nonspecific. The imaging modality of choice is CT scan, which reveals a large cystic image dependent on the sigmoid colon. Definitive treatment is surgical, either by resecting the affected segment including the lesion or by performing a simple diverticulectomy in uncomplicated cases.
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Affiliation(s)
- María de Armas-Conde
- Cirugía General y del Aparato Digestivo, Hospital Universitario Nuestra Señora de la Candelaria, España
| | | | | | - Jorge Abellán-Fernández
- Cirugía General y del Aparato Digestivo, Hospital Universitario Nuestra Señora de la Candelaria
| | - Javier Padilla-Quintana
- Cirugía General y del Aparato Digestivo, Hospital Universitario Nuestra Señora de la Candelaria
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Bunjo Z, Goh SK, Lee H, Tan CP. Perforated duodenal diverticulum: protecting the ampulla through the imbrication technique of repair. ANZ J Surg 2023; 93:2250-2251. [PMID: 36976785 DOI: 10.1111/ans.18429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Zachary Bunjo
- Hepatopancreatobiliary Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Su Kah Goh
- Hepatopancreatobiliary Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hong Lee
- Hepatopancreatobiliary Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Chuan Ping Tan
- Hepatopancreatobiliary Surgery Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Sako Y, Hirata T. Hysteroscopic management of uterine diverticulum after myomectomy: a case report. BMC Womens Health 2023; 23:452. [PMID: 37641054 PMCID: PMC10464432 DOI: 10.1186/s12905-023-02606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND A uterine diverticulum is defined as the presence of a niche within the inner contour of the uterine myometrial wall. Although secondary uterine diverticula can occur after hysterotomy such as cesarean section, reports of diverticula after myomectomy are extremely rare. CASE PRESENTATION A 45-year-old nulliparous woman undergoing infertility treatment was referred to our hospital because of abnormal postmenstrual bleeding after myomectomy. Transvaginal sonography and magnetic resonance imaging revealed a diverticulum in the isthmus. Fat-saturated T1 image showed a blood reservoir in the diverticulum. Hysteroscopic surgery was performed to remove the lowed edge of the defect and coagulate the hypervascularized area. Two months after surgery, the abnormal postmenstrual bleeding and chronic endometritis improved. DISCUSSION AND CONCLUSIONS This report highlights the similarities of the patient's diverticulum to cesarean scar defects in terms of symptoms and pathophysiology. First, this patient developed a diverticulum with hypervascularity after myomectomy and persistent abnormal bleeding. Second, after hysteroscopic surgery, the symptoms of irregular bleeding disappeared. Third, endometrial glands were identified within the resected scar tissue. Fourth, preoperatively identified CD138-positive cells in endometrial tissue spontaneously disappeared after hysteroscopic resection. To the best of our knowledge, this is the first report of symptomatic improvement following hysteroscopic surgery in a patient with an iatrogenic uterine diverticulum with persistent irregular bleeding after myomectomy.
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Affiliation(s)
- Yusuke Sako
- Department of Obstetrics and Gynecology, St Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Tetsuya Hirata
- Department of Obstetrics and Gynecology, St Luke's International Hospital, 9-1 Akashi-Cho, Chuo-Ku, Tokyo, 104-8560, Japan.
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan.
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Syarif S, Azis A, Patimura MIF, Putra MZDA, Nusraya A, Natsir AS. Giant stone in a urinary bladder diverticulum in a 69-year-old male: a case report. Pan Afr Med J 2023; 45:181. [PMID: 38020350 PMCID: PMC10656586 DOI: 10.11604/pamj.2023.45.181.38723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/30/2023] [Indexed: 12/01/2023] Open
Abstract
The stone formation could occur due to urine stasis in the bladder diverticulum. However, the stones are usually smaller in size and can pass spontaneously. However, a giant stone inside vesical diverticulum is considered a rare entity. We report a 69-year-old male, with a two-year history of lower urinary tract symptoms along with a recurrence of urinary tract infection. An abdominal computed tomography scan revealed the presence of a giant bladder diverticulum and a large bladder stone. The patient underwent a transurethral bladder neck incision followed by diverticulectomy with stone extraction. The diverticulum size measures 6x4x3.8 cm and diverticulum stone size of 4x3x3 cm. Fortunately, the patient recovered well after the operation. In conclusion, giant stones inside large vesical diverticulum are a rare occurrence and should be considered in patients with lower urinary tract symptoms. Early diagnosis and optimal management of the obstruction are the principles to prevent long-term complications.
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Affiliation(s)
- Syarif Syarif
- Department of Surgery, Faculty of Medicine Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | - Abdul Azis
- Department of Surgery, Faculty of Medicine Hasanuddin University, Makassar, South Sulawesi, Indonesia
| | | | | | - Ade Nusraya
- General Practicioner, Siloam Hospital, Makassar, South Sulawesi, Indonesia
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Zhou W, Lang Y, Xu Z, Yin D. Rare and unexpected ventilation difficulties due to tracheal diverticulum: A case report. Medicine (Baltimore) 2023; 102:e34536. [PMID: 37565856 PMCID: PMC10419496 DOI: 10.1097/md.0000000000034536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
RATIONALE Tracheal diverticulum is a rare airway-related particular occurrence, and the forcible tube insertion may cause tracheal ruptures during tracheotomy. Therefore, fiberoptic bronchoscopy (FOB) should be used routinely on all patients undergoing tracheal intubation or tracheotomy. PATIENT CONCERNS A 60-year-old male with laryngeal neoplasms was scheduled for partial laryngectomy using a suspension laryngoscope in July 2020. All operations were performed under general anesthesia through orotracheal intubation. Orotracheal intubation was a noninvasive procedure that could effectively control breathing. At the end of the surgery, the percutaneous tracheostomy was performed to maintain airway patency, facilitate spontaneous respiration, and remove the secretions. DIAGNOSES At this moment, the tracheal diverticulum, located at the right posterolateral region of the trachea, became an unexpected airway-related particular occurrence, which led to tracheal tube placement difficulty, mechanical ventilation difficulty, and high airway pressure. INTERVENTIONS Subsequently, the tracheal tube was repositioned, with placement again confirmed by the FOB. LESSONS SUBSECTIONS Tracheal diverticulum is an infrequent cause of tube inserting difficulty for the tracheotomy, and FOB is the first option for patients with catheter placement difficulty and mechanical ventilation difficulty.
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Affiliation(s)
- Weiwei Zhou
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Yantao Lang
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhongling Xu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Dekun Yin
- Department of Anesthesiology, Funing People’s Hospital of Jiangsu, Yancheng, Jiangsu Province, China
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Kawatake R, Maebayashi A, Nishimaki H, Nagaishi M, Kawana K. Successful surgical treatment of postmyomectomy uterine diverticulum: a case report. BMC Womens Health 2023; 23:406. [PMID: 37537601 PMCID: PMC10398967 DOI: 10.1186/s12905-023-02539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Uterine diverticulum is classified into congenital and acquired types. The acquired type is caused by caesarean scar syndrome, which occurs after caesarean section. There are no detailed reports on diverticulum after enucleation of uterine fibroids. Most cases are treated with hysteroscopy or laparoscopy, but a management consensus is lacking. We treated a patient with a uterine diverticulum that had formed after uterine fibroid enucleation by combining hysteroscopic and laparoscopic treatments. CASE PRESENTATION The patient was a 37-year-old Japanese woman, G1P0. A previous doctor had performed abdominal uterine myomectomy for a pedunculated subserosal uterine fibroid on the right side of the posterior wall of the uterus near the internal cervical os. Menstruation resumed postoperatively, but a small amount of dark-red bleeding persisted. MRI two months after the myomectomy revealed a diverticulum-like structure 3 cm in diameter, communicating with the uterine lumen, on the right side of the posterior wall of the uterus. Under suspicion of uterine diverticulum after uterine fibroid enucleation, the patient sought treatment at our hospital approximately four months after the myomectomy. Through a flexible hysteroscope, a 5-mm-diameter fistula was observed in the posterior wall of the uterus, and a contrast-enhanced pocket, measuring approximately 3 cm, was located behind it. Uterine diverticulum following enucleation of a uterine fibroid was diagnosed, and surgery was thus deemed necessary. The portion entering the fistula on the internal cervical os side was resected employing a hysteroscope. Intra-abdominal findings included a 4-cm mass lesion on the posterior wall on the right side of the uterus. The mass was opened, and the cyst capsule was removed. A 5-mm fistula was detected and closed with sutures. Resuturing was not performed after dissection of the right round ligament due to tension. The postoperative course has been good to date, with no recurrence. CONCLUSION Uterine diverticula after myomectomy may be treated with a combined laparoscopic and hysteroscopic approach, similar to caesarean scar syndrome.
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Affiliation(s)
- Rina Kawatake
- Department of Obstetrics and Gynecology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Aki Maebayashi
- Department of Obstetrics and Gynecology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan.
| | - Haruna Nishimaki
- Department of Pathology and Microbiology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Masaji Nagaishi
- Department of Obstetrics and Gynecology, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
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44
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Fernandez-Alberti J, Coronil R, Iotti A, Nolazco A, Featherston M. Calyceal diverticulum simulating a renal tumor. Can J Urol 2023; 30:11629-11632. [PMID: 37633292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Calyceal diverticulum (CD) is a rare anatomic anomaly with an incidence of 0.2% to 0.6% in the patients undergoing renal imaging. They are considered benign lesions and malignancy is exceedingly rare. For diagnosis it is suggested to perform a multiphasic contrast-enhanced computed tomography (CT) evidencing a diverticulum of the pelvicalyceal system with thin-walled cavities communicating with the central collecting system. However, they can be usually mistaken as kidney cancers leading to unjustified nephrectomy. Here, we present a case of a 34-year-old patient who underwent surgery in 2022 due to suspected kidney cancer and histopathological analysis surprisingly reported a CD.
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Affiliation(s)
| | - Ramon Coronil
- Department of Imaging Diagnostic, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Iotti
- Department of Anatomic Pathology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Nolazco
- Department of Urology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Featherston
- Department of Urology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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45
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Barba M, Cola A, Rezzan G, Frigerio M. Transvaginal excision of urethral diverticulum: A video case report. Eur J Obstet Gynecol Reprod Biol 2023; 286:154-156. [PMID: 37263833 DOI: 10.1016/j.ejogrb.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Marta Barba
- Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Monza, Italy.
| | - Alice Cola
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giorgia Rezzan
- Fondazione IRCCS San Gerardo dei Tintori, Ospedale San Gerardo, Monza, Italy
| | - Matteo Frigerio
- Fondazione IRCCS San Gerardo dei Tintori, Ospedale San Gerardo, Monza, Italy
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46
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Oamen E, Lowrey T, Tran H, Patel S, Rensing A. Robot-assisted Laparoscopic Urethral Diverticulectomy in a Pediatric Patient. Urology 2023; 177:181-183. [PMID: 37044311 DOI: 10.1016/j.urology.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
Urethral diverticula are rare in children, especially in the absence of trauma. We present a case of a 9-year-old girl with pain with micturition, incontinence, and recurrent urinary tract infections. Diagnosis of urethral diverticulum was made by magnetic resonance imaging. A robot-assisted transabdominal laparoscopic diverticulectomy was performed without complication. The patient experienced a significant improvement in symptoms.
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Affiliation(s)
| | - Thomas Lowrey
- OU College of Medicine Department of Urology, Oklahoma City, OK
| | - Hanh Tran
- Oklahoma Children's Hospital OU Health, Oklahoma City, OK
| | - Sanjay Patel
- OU College of Medicine Department of Urology, Oklahoma City, OK
| | - Adam Rensing
- OU College of Medicine Department of Urology, Oklahoma City, OK; Oklahoma Children's Hospital OU Health, Oklahoma City, OK.
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47
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Lilly JL, Newstrom E, Mohyuddin N. Posterior Tracheal Diverticulum in a Patient Undergoing Tonsillectomy. JAMA Otolaryngol Head Neck Surg 2023; 149:649-650. [PMID: 37200011 DOI: 10.1001/jamaoto.2023.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
This case report describes a male patient in his 20s who presented with bilateral palatine tonsil enlargement and history of infections 4 to 5 times per year and was subsequently found to have tracheal diverticulum.
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Affiliation(s)
- James Landry Lilly
- Engineering Medicine (EnMed) Intercollegiate School of Engineering Medicine, College of Medicine, Texas A&M University (TAMU-COM), Houston, Texas
| | - Emily Newstrom
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Nadia Mohyuddin
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell College of Medicine, Houston Methodist Hospital, Houston, Texas
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48
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Dean NS, Guo JN, Krambeck AE. Percutaneous management of caliceal diverticula: a narrative review. Curr Opin Urol 2023; 33:333-338. [PMID: 36861758 DOI: 10.1097/mou.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW Caliceal diverticula are relatively uncommon within urologic practice and may be difficult to diagnose and treat. We aim to highlight contemporary studies examining surgical interventions for patients with caliceal diverticula, with a focus on percutaneous intervention, and provide updated practical recommendations for the management of these patients. RECENT FINDINGS Studies within the last 3 years examining surgical treatment options for caliceal diverticular calculi are limited. When flexible ureteroscopy (f-URS) and percutaneous nephrolithotomy (PCNL) are examined within the same observational cohorts, PCNL is associated with improved stone-free rates (SFRs), lower requirement for re-intervention, and longer lengths of stay (LOS). Retrograde f-URS for the treatment of caliceal diverticula and diverticular calculi is associated with satisfactory safety and efficacy outcomes. There are no studies in the last 3 years that provide supporting evidence to use shock wave lithotripsy to treat caliceal diverticular calculi. SUMMARY Recent studies examining surgical interventions for patients with caliceal diverticula are limited to small observational studies. Heterogeneity in LOS and follow-up protocol limits comparisons between series. Despite technological advancements in f-URS, PCNL appears to be associated with more favorable and definitive outcomes. PCNL continues to be the preferred treatment strategy for patients with symptomatic caliceal diverticula when deemed technically feasible.
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Affiliation(s)
- Nicholas S Dean
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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49
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Welch EK, Dengler KL, Welgoss JA. Urethral Diverticulum Marsupialization With Modified Spence-Duckett Procedure. Urology 2023; 176:248. [PMID: 36963669 DOI: 10.1016/j.urology.2023.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE To demonstrate a modified approach to the Spence-Duckett procedure for treatment of a distal urethral diverticulum. A urethral diverticulum is an outpouching of urethral mucosa occurring in 2-5% of the population.1 They are thought to commonly arise due to chronic inflammation or infection of the peri-urethral glands.2,3 MATERIALS AND METHODS: We present a 37-year-old female with vaginal bulge, dyspareunia, and dysuria. On examination, she had a 2-centimeter tender mass abutting the distal urethra. Imaging such as ultrasound or magnetic resonance imaging is critical to map the location of the diverticula along the urethra and extent of urethral involvement as it can inform surgical technique. Diverticula are typically located postero-laterally at the mid- or distal urethra; however, they can be found at any location along the urethra.2,3 Care must be taken to avoid disruption of the continence mechanism at the mid-urethra to prevent incontinence after surgery. Magnetic resonance imaging revealed a 1.7 × 1.7 × 1.8 centimeter unilocular cystic structure at the left posteromedial distal urethra consistent with a urethral diverticulum. The patient desired surgical management. RESULTS Spence and Duckett traditionally described insertion of one blade of the Metzenbaum scissors in the urethra with incision into the diverticulum and anterior vaginal wall followed by marsupialization.4 Given the small size of the diverticular ostium identified, we opted to make an incision using a scalpel from the ostium down the posterior aspect of the urethra and proximally to the anterior vaginal wall. We then excised the diverticular sac prior to marsupialization. At 6 weeks after surgery, she had full resolution of her symptoms without development of urinary incontinence. Pathologic examination is important because while rare, cancers can originate from urethral diverticula, with a prevalence of 6-9%.5 Pathology was consistent with urethral diverticulum and negative for dysplasia. CONCLUSION While effective, the Spence-Duckett technique is described as a "generous meatotomy" with risks of urethral shortening. Our modified approach reduces these risks, resolves bothersome symptomatology, improves cosmesis, and minimizes risk of anatomic or functional urethral compromise.
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Affiliation(s)
- Eva K Welch
- Division of Urogynecology, Walter Reed National Military Medical Center, Bethesda MD.
| | - Katherine L Dengler
- Division of Urogynecology, Walter Reed National Military Medical Center, Bethesda MD
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Merriman AL, Peterkin VC, Myers EM, Kennelly M. Patients' Perspectives: Outcomes of Modified Marsupialization for Treatment of Female Urethral Diverticula. Urogynecology (Phila) 2023; 29:452-457. [PMID: 36730945 DOI: 10.1097/spv.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | | | - Erinn M Myers
- From the Division of Urogynecology and Pelvic Surgery
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