Risk factors of postoperative sexual function in patients with urethral diverticulum and their partners: A cohort study of 83 women

ABSTRACT Introduction and Objective: Several studies have focused on the treatment and recurrence of urethral diverticulum (UD). However, few investigations have addressed sexual function in patients with UD. Therefore, we sought to examine sexual function in women affected by UD. Materials and Methods: There were 108 accepted cases involving transvaginal diverticulectomy at our institution. Ultimately, 83 women were included for further analysis, only 61 of these women had sexual partners. We collected data for the Female Sexual Function Index (FSFI) from the female patients and the Male Sexual Health Questionnaire (MSHQ) from their male partners before and after surgery. Results: Preoperatively, the UD size affected the female patient's arousal and lubrication (p=0.04), and the UD location affected their satisfaction. However, no significant between-group differences were found in the total FSFI score. For all women, sexual activity improved after surgery (p=0.0087). In addition to improvements in arousal for women with a large UD, improvements in lubrication were affected by the UD size, number and shape, increases in satisfaction scores were impacted by the UD location and shape, and pain relief was linked to the UD number and shape. Analysis of the MSHQ results revealed no between-group differences among the male partners. Conclusion: Only the UD size and location affected sexual function in women with a small UD. Surgery could improve female sexual function but did not affect the sexual function of the patient's partners.

Divertículo duodenal simulando neoplasia quística de páncreas / Duodenal diverticulum as a cystis neoplasm of pancreas

Resumen Objetivo: El divertículo duodenal se presenta con una frecuencia del 1 al 23% según series radiológicas y de autopsias. La localización más frecuente es la segunda porción duodenal cercana a la cabeza pancreática, por lo cual puede ser confundido con neoplasias pancreáticas quísticas. Material y Método: Presentamos un paciente con diagnóstico de sospecha radiológica, mediante ecoendoscopia y punción aspiración con aguja fina (PAAF), de neoplasia mucinosa de páncreas que fue intervenido, encontrándose un endurecimiento de la cabeza pancreática y un divertículo duodenal yuxtavateriano, realizándose extirpación en bloque ante la sospecha de malignidad. Resultado: El posoperatorio del paciente fue favorable y el resultado anatomopatológico del tejido pancreático informó de tejido pancreático sin anomalías y divertículo duodenal. Discusión: El diagnóstico diferencial preoperatorio del divertículo duodenal con la neoplasia mucinosa quística de páncreas es muy complejo, ya que la punción del líquido del interior del divertículo puede ser similar al de un proceso neoplásico mucinoso pancreático. Ante la sospecha diagnóstica y la presencia de clínica está indicado realizar laparotomía exploradora, para obtener un diagnóstico de certeza.

Objective: The duodenal diverticulum presents with a frequency of 1 to 23% according to radiological series and autopsies. The most frequent localization is the second duodenal portion near the pancreatic head so it may be confused with cystic pancreatic neoplasms. Material and Method: We present a patient with diagnosis of radiological suspicion by means of echoendoscopy and fine needle aspiration biopsy (FNAB) of a mucinous neoplasm of the pancreas that was intervened, being a hardening of the pancreatic head and a duodenal juxtavaterian diverticulum, being performed a block removal on suspicion of malignancy. Result: The patient's postoperative period was favorable and the anatomopathological result of the pancreatic tissue was of pancreatic tissue without anomalies and duodenal diverticulum. Discussion: The preoperative differential diagnosis of duodenal diverticulum with mucinous cystic neoplasia of the pancreas is very complex, since the puncture of the fluid inside the diverticulum may be similar to that of a neoplastic process of the pancreatic mucin. Before the suspected diagnosis and the presence of clinic is indicated to perform exploratory laparotomy, to obtain a diagnosis of certainty.

Jejunal diverticulitis as a cause of acute abdomen / Abdome agudo por diverticulite de jejuno

Jejunoileal diverticulosis is an uncommon and underdiagnosed condition. Most patients are asymptomatic and require no specific treatment. A few patients, however, present life-threatening complications that may require surgical intervention. The purpose of this report is to illustrate a case of jejunoileal diverticulosis manifested as an acute abdomen.

A doença diverticular do intestino delgado é uma entidade incomum e pouco diagnosticada. A maioria dos casos não apresenta sintomas e não necessita de tratamento específico. Alguns pacientes, no entanto, podem evoluir com complicações da doença e necessitar de tratamento cirúrgico. O objetivo deste relato é ilustrar um caso de diverticulose jejunal que evoluiu para um quadro de abdome agudo.

Factores predictivos de conversión laparoscópica en el tratamiento electivo de la enfermedad diverticular / Predictive factors of laparoscopc conversion in the elective treatment of diverticular disease

Introducción: en las últimas décadas la utilización del abordaje laparoscópico en el tratamiento de enfermedades colorrectales, ha experimentado un auge significativo, logrando disminuir la morbimortalidad del tratamiento. Estos beneficios se pierden ante la necesidad de conversión. Objetivos: nos propusimos identificar los factores preoperatorios predictivos de conversión del procedimiento laparoscópico, en el tratamiento electivo de la enfermedad diverticular validando su aplicación, y evaluar las consecuencias de la conversión. Material y método: se realizó un estudio retrospectivo, descriptivo, observacional de los pacientes con diagnóstico de enfermedad diverticular, operados electivamente por técnica laparoscópica, en el Servicio de Coloproctología del Hospital Británico de Buenos Aires, durante el período comprendido entre junio de 1993 y junio de 2011. Se evaluaron las siguientes variables: edad, sexo, el índice de masa corporal, el riesgo quirúrgico según la American Society of Anesthesiologists (ASA), existencia de cirugías previas, motivo de indicación de cirugía, el tiempo operatorio, la recuperación del tránsito intestinal y la duración de la estadía hospitalaria. Se realizó un análisis univariado de las variables preoperatorias e intraoperatorias. Utilizando la prueba t de Student, se tomó estadísticamente significativo un valor de p < 0,05. Comparamos la morbilidad en relación a dichas variables. Resultados: se realizaron 126 procedimientos, 97 exclusivamente por laparoscopía y 29 requirieron de una laparotomía para su resolución. La edad promedio de la serie fue de 62,3 años de edad (rango 31-88). Setenta y nueve correspondiendo al sexo masculino (62.9%) y 47 al sexo femenino (37.3%). El IMC promedio fue de 25,1 kg/m2. Ochenta y cuatro pacientes fueron clasificados como ASA 1; 35, ASA 2 y 7, ASA 3... (TRUNCADO).

Background: in recent decades the use of laparoscopy in the treatment of colorectal diseases, has experienced an increase significant, achieving treatment reduce morbidity and mortality. These benefits are lost with the conversion. Objectives: we proposed identify preoperative factors predictive of conversion of laparoscopic procedure in the elective treatment of diverticular disease, validating their application, and evaluate consequences of the conversion. Material and methods: retrospective, descriptive, observational study of patients with diagnosis of diverticular disease, were electively operated by laparoscopic technique in the service of Coloproctology British Hospital of Buenos Aires during the period between June 1993 and June 2011. Following variables were evaluated: age, sex, body mass index, surgical risk according to the American Society of Anesthesiologists (ASA), existence of previous surgery, reason for surgery indication, operative time, recovery of intestinal transit and time of hospital stay. A univariate analysis of preoperative and intraoperative variables was performed. Using the Student t test, a P value <0.05 was statistically significant take. We compared morbidity in relation to these variables. Results: one hundred and twenty-six procedures were performed. Ninety-seven exclusively by laparoscopy and 29 laparotomy required for resolution. The average age of the series was 62.3 years (range 31-88). Seventy-nine corresponding males (62.9%) and 47 females (37.3%). The average BMI was 25.1 kg/m2. Eighty-four patients were classified as ASA 1, 35, 2 and 7 ASA, ASA 3. Seventy-four patients had a history of previous abdominal surgery (58.7%). Ninety-four (74.6%) patients corresponded to uncomplicated diverticulitis, and 32 (25.3%) present complicated diverticulitis. Operative time was 175 minutes for the laparoscopic group, while for the conversion group was 262 minutes. The conversion rate of the series was 23% (29/126)... (TRUNCADO).

Complicated diverticular disease: the changing paradigm for treatment / Doença diverticular complicada: alterando o padrão de tratamento

The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.

O termo diverticulite "complicada" é reservado para a doença diverticular complicada por sangramento, abscesso, peritonite, fístula ou obstrução intestinal. A hemorragia é melhor tratada por angioembolização (radiologia intervencionista). O tratamento de diverticulite infectada evoluiu enormemente graças a: 1) ressecção laparoscópica do cólon seguida ou não (procedimento de Hartmann) pelo restabelecimento de continuidade intestinal, 2) lavado laparoscópico simples (peritonite + / - ressecção). A diverticulite (inflamação) pode ser tratada somente com antibióticos, anti-inflamatórios, combinados com repouso e medidas de higiene. O abscesso diverticular (Hinchey graus I, II) pode ser inicialmente tratado somente com antibióticos e / ou drenagem percutânea, dependendo do tamanho do abcesso. A peritonite purulenta generalizada (Hinchey III) pode ser tratada pelo clássico procedimento Hartmann, pela exteriorização da perfuração, como se fosse um estoma, pela ressecção primária com ou sem anastomose, com ou sem desvio do trânsito e, por último, a simples lavagem laparoscópica, geralmente, sem drenagem. A peritonite por fezes (Hinchey IV), uma indicação para o tradicional procedimento de Hartmann, também pode se beneficiar da ressecção primária seguida de anastomose, com ou sem desvio e lavagem laparoscópica. A obstrução aguda (inflamação local, ou aderências, formação pseudotumoral, estenoses crônicas) e fístula são, na maioria das vezes, tratadas por ressecção, preferencialmente, laparoscópica. Algoritmos terapêuticos pouco invasivos combinadas com indicações menos rigorosas para a o emprego da cirurgia radical antes de um padrão definido de recorrência, estão estabelecidos, ocasionando um número menor de ressecções e / ou estomas, reduzindo a morbidade e a mortalidade, melhorando a qualidade de vida após a intervenção, e geram uma tratamento menos dispendioso.

Huge uterine-cervical diverticulum mimicking as a cyst.

Here we report an incidental huge uterine-cervical diverticulum from a total abdominal hysterectomy specimen in a perimenopausal woman who presented with acute abdominal pain. The diverticulum was mimicking with various cysts present in the lateral side of the female genital tract. Histopathological examination confirmed this to be a cervical diverticulum with communication to uterine cavity through two different openings. They can attain huge size if left ignored for long duration and present a diagnostic challenge to clinicians, radiologists, as well as pathologists because of its extreme rarity. Therefore, diverticula should also be included as a differential diagnosis. Its histopathological confirmation also highlights that diverticula can present as an acute abdomen, requiring early diagnosis with appropriate timely intervention. Immunohistochemistry CD 10 has also been used to differentiate it from a mesonephric cyst.

Complicated jejunal diverticulitis: a challenging diagnosis and difficult therapy

In contrast to diverticulosis of the colon, jejunal diverticulosis is a rare entity that often becomes clinically relevant only after exacerbations occur. The variety of symptoms and low incidence make this disease a difficult differential diagnosis. Data from all patients who were treated in our surgical department for complicated jejunal diverticulitis, that is, gastrointestinal hemorrhage or a diverticula perforation were collected prospectively over a 6-year period [January 2004 to January 2010] and analyzed retrospectively. The median age among the 9 patients was 82 years [range: 54-87]. Except for 2 cases [elective operation for a status postjejunal peridiverticulitis and a re-perforation of a diverticula in a patient s/p segment resection with free perforation], the diagnosis could only be confirmed with an exploratory laparotomy. Perforation was observed in 5 patients, one of which was a retroperitoneal perforation. The retroperitoneal perforation was associated with transanal hemorrhage. Hemodynamically relevant transanal hemorrhage requiring transfusion were the reason for an exploratory laparotomy in 2 further cases. In one patient, the hemorrhage was the result of a systemic vasculitis with resultant gastrointestinal involvement. A singular jejunal diverticulum caused an adhesive ileus in one patient. The extent of jejunal diverticulosis varied between a singular diverticulum to complete jejunal involvement. A tangential, transverse excision of the diverticulum was carried out in 3 patients. The indication for segment resection was made in the case of a perforation with associated peritonitis [n=4] as well as the presence of 5 or more diverticula [n=2]. Histological analysis revealed chronic pandiverticulitis in all patients. Median operating time amounted to 142 minutes [range: 65-210] and the median in-hospital stay was 12 days [range: 5-45]. Lethality was 0%. Major complications included secondary wound closure after s/p repeated lavage and bilateral pleural effusions in one case. Signs of malabsorption as the result of a short bowel syndrome were not observed. Minor complications included protracted intestinal atony in 2 cases and pneumonia in one case. Median follow-up was 6 months [range: 1-18]. Complicated jejunal diverticulitis often remains elusive preoperatively due to its unspecific clinical presentation. A definitive diagnosis can often only be made intraoperatively. The resection of all diverticula and/or the complete diverticula-laden segment is the goal in chronic cases. The operative approach chosen [tangential, transverse excision vs segment resection] should be based on the extent of the jejunal diverticulosis as well as the intraoperative findings

Conduta no tratamento do divertículo de uretra feminina / Treatment approach to female urethral diverticulum

Os divertículos de uretra feminina são incomuns e são mais freqüentes entre a terceira e a quinta décadas de vida. Geralmente é diagnosticado tardiamente. A maioria dos divertículos de uretra está relacionada à infecções recorrentes das glândulas periuretrais ou ao traumatismo uretral. . A uretrocistografia e a ressonância magnética são os métodos de imagem de maior valor no diagnóstico desta doença. O tratamento de eleição e a ressecção do divertículo.

Female urethral diverticula are uncommon and are more frequent between the third and fifth decades of life. They are usually diagnosed late. Most urethral diverticula are related to recurrent infections of the periurethral glands or urethral trauma. Cystourethrography and magnetic resonance imaging are the most valuable diagnostic methods. The treatment of choice is thte resection of the diverticulum.

Divertículo calicial. Técnica quirúrgica: nuestra casuística / Caliceal diverticula. Surgical technique: report of cases

Objetivo: evaluar la tasa libre de cálculo y de obliteración del divertículo, con la técnica percutánea, en el tratamiento quirúrgico de los divertículos caliciales asociados a litiasis. Materiales y Métodos: se revisaron las historias clínicas de pacientes operados por divertículo calicial asociado a litiasis en su interior de 2004 a 2010. Fueron evaluados con Urocultivo, Rx simple de árbol urinario, Urograma Excretor y Tomografía de abdomen y pelvis. Se determinó la presencia del divertículo, su asociación a litiasis y su proyección anterior o posterior. Se realizó nefrolitotricia percutánea (NLPC) más dilatación del cuello del divertículo en todos los casos. Con respecto a la técnica quirúrgica, en decúbito ventral, previa colocación de un catéter ureteral tipo "open end". Se accedió directamente al divertículo, con dilatación hasta 30 Fr. Luego de realizar la litotricia neumática y extraer los fragmentos litiásicos, se dilató el cuello del divertículo hasta 18 Fr, dejando luego un catéter doble jota o un tubo de nefrostomía a través del cuello del mismo hasta la pelvis renal. Los resultados respecto a los restos litiásicos y al divertículo se evaluaron en el postquirúrgico inmediato con Rx árbol urinario y urocultivo, a los 6 meses con Urograma Excretor y luego anualmente con ecografía. Resultados: 11 pacientes fueron tratados con NLPC por divertículos caliciales asociados a litiasis. La edad promedio fue de 41,8 años (14-58). El seguimiento medio fue de 29,7 meses (12-70). Los 11 divertículos tenían proyección posterior y estaban asociados a liltiasis renal. En todos los casos se pudo identificar el cuello diverticular y se realizó la dilatación del mismo. En 8 pacientes se dejó un catéter doble J desde el divertículo hasta la vejiga y en 3 un tubo de nefrostomía (K-11) desde el divertículo hasta la pelvis renal. Ninguno de los pacientes presentó sangrado con requerimiento de transfusión, neumotórax ni hemotórax. La tasa libre de cálculo fue del 10%...

Objective: Assessing the stone-free rate and diverticulum obliteration with percutaneous technique in the managment of the caliceal diverticula associated with stones. Material and methods: We reviewed medical records of patients undergoing surgery for calyceal diverticulum associated with lithiasis from 2004 to 2010. They were evaluated by urine culture, simple urinary Rx, intravenous urography and CT. Percutaneous nephrolithotomy (PCNL) plus dilatation of the diverticular neck was performed in all cases. First an ureteral catheter open end type was placed. In prone position the diverticulum was accessed directly. After pneumatic lithotripsy and extraction of fragments, diverticular neck was dilated to 20 Fr, leaving a double J catheter or a nephrostomy tube. The results were evaluated immediately after surgery with urinary Rx and urien culture, at 6 months with intravenous urography and annual follow-up with ultrasound. Results: 11 patients were treated with PCNL for caliceal diverticula with stones. The mean age was 41,8 years (range 14-58). The mean follow up was 29,7 months (range 12-70). All caliceal diverticulum had a posterior projection. In all cases the diverticular neck was identify and the dilation was performed. None of the patients experienced pneumothorax or hemothorax and blood transfusions were not required. The stone-free rate was 100%, all patients had complete remission of symptoms. No recurrence of the diverticulum was observed during the follow up. Conclusions: the results proves that percutaneous management with dilation of the diverticular neck is secure, effective and mini invasive technique for the treatment of the caliceal diverticula associated with stones

Impact of juxta-ampullary duodenal diverticula on ERCP complications

Juxta-ampullary diverticulum is an acquisitive disorder generally observed in patients over the age of forty years. The purpose of this study is to evaluate the relationship between this abnormality and the incidence of post-ERCP complications. This was a case-control cross-sectional study that compared post- ERCP complications between patients with juxta-ampullary diverticula and those with no juxta-ampullary diverticula. We classified diverticula based on anatomic locations with respect to the ampulla. A total of 718 patients referred to our endoscopic ward during one year for ERCP. From these cases, 685 patients underwent ERCP. A total of 47 [6.9%] patients had juxta-ampullary diverticuli, which consisted of type A [25.5%], type B [46.8%], type C [12.8%] and type D [14.9%]. The frequency of CBD stones and cholangitis in the case group was significantly more than die control group [p<0.00l]. The mean age of patients in the case group was ten years older than patients in die control group [68.04dbl5.02 vs. 58.25 +/- 17.48], which was significant [p<0.00l]. There is an association between juxta-ampullary diverticula and the frequency of CBD stones and post-ERCP complications

Divertículo de la tercera porción del duodeno: presentación de un caso y revisión de la literatura / Diverticulum in the third portion of the duodenum: case report and review of the literature

Introducción: el duodeno representa el segundo sitio más común de desarrollo de divertículos, después del colon. Se encuentran generalmente a 2,5 cm de la ampolla de Vater o en la primera porción duodenal, en casos relativamente raros, se presentan en la tercera y cuarta porción duodenal. Objetivo: presentación de un caso de divertículo en tercera porción duodenal, así como también la metodología diagnóstica y terapéutica para resolverlo. Discusión: el diagnóstico clínico de los divertículos duodenales presenta dificultad debido a que no existe una presentación clínica característica. Sólo el 10% y 25% de los pacientes son sintomáticos. Las manifestaciones clínicas se desarrollan por las complicaciones de las diverticulitis. El diagnóstico se basa en los estudios contrastados como las seriadas esofagogastroduodenales, TAC multicorte, así como también, la realización de una endoscopía, deben contribuir a un diagnóstico acertado. El tratamiento quirúrgico de los divertículos asintomático en pacientes adultos no está justificado, mientras que en el paciente con síntomas el criterio es quirúrgico para evitar complicaciones como: hemorragia, perforación, diverticulitis, pancreatitis y obstrucción. Conclusión: el tratamiento de los divertículos duodenales varía según el tipo, localización y extensión del proceso inflamatorio. La cirugía se encuentra reservada en un 1 al 3% de los pacientes con divertículos duodenales en tercera porción, considerando aquellos enfermos con dolor abdominal persistente o complicaciones asociadas a la diverticulitis.

Introduction: The duodenum is the second most common site of diverticula development after the colon. They are usually found to 2.5 cm of the ampulla of Vater or the first part of the duodenum, in relatively rare cases, occur in the third and fourth duodenal portion. Objective: A case of duodenal diverticulum in the third portion, as well as diagnostic and therapeutic methodology to solve it. Discussion: The diagnosis of duodenal diverticula have difficulty because there is no characteristic clinical presentation. Only 10% and 25% of patients are symptomatic. The clinical manifestatiions are developed by the complications of diverticulitis. The diagnosis is bases on serial contrast studies such as upper GI, multislice CT, and also carrying out an endoscopy, should contribute to an accurate diagnosis. Surgical treatment of asymptomatic diverticula in adult patients is not justified, whereas in patients with symptoms on surgical approach is to avoid complications such as bleeding, perforation, diverticulitis, pancreatitis and obstruction. Conclusion: The treatment of duodenal diverticula varies according to the type, location and extent of the inflammatory process. Surgery is reserved on a 1 to 3% of patients with duodenal diverticula in the third portin, whereas those patients with persistent abdominal pain or complications associated with diverticulitis.

Complicated Jejunal diverticula as surgical emergency: experience at a tertiary care hospital in Peshawar, Pakistan

Diverticula of small intestine are rare. Jejunal diverticula can be single or multiple. Diverticula in the jejunum tend to be large and multiple. Clinically they may be asymptomatic or may give rise to symptoms like pain, flatulence and borborygmi, may produce malabsorption syndrome or may present in emergency with different acute pathologies like perforation, haemorrhage, obstruction, enterolith formation and inflammation. The Objective was to see the pattern of complications in jejunal diverticula presenting as a surgical emergency. This descriptive study was conducted at Surgical Units of the 3 tertiary care Hospitals of Peshawar, for 7 years from January 1, 2002 to December 31, 2008. Study included all patients presenting to and admitted in Surgical Unit, Hayatabad Medical Complex, Peshawar with complicated jejuna diverticula during the above mentioned period. Name, age, sex, other relevant data, history and examination findings and results of investigation were recorded. Uncomplicated jejuna diverticula were excluded from study. The operative findings and the type of complication were recorded. Ten patients were admitted during 7 years of study. Out of all patients 9 were male and 1 was female. Eight out of 10 patients presented with perforation of diverticula while 1 patient had severe inflammation of diverticulum causing pain, ileus and acute abdomen. One patient had acute pain due to adhesion formation. It is seen that complicated jejunal diverticulae are quite rare and the most common complication is perforation. Inflammation and adhesion are other complications with which jejunal diverticula presented during this study

Anterior urethral valves and diverticulum.

Anterior urethral valves with associated urethral diverticulum is a rare but important cause of infravesical obstructive uropathy in children. This condition can be a cause of significant morbidity and can even lead to end-stage renal disease. This rare condition should be included in the differential diagnosis while evaluating male infants with infravesical obstructive uropathy.

Divertículo duodenal en la tercera porción del duodeno como causa de sangrado del tubo digestivo alto y dolor crónico abdominal: informe de un caso y revisión de la literatura / Duodenal diverticulum in the third portion of duodenum as a cause of upper gastrointestinal bleeding and chronic abdominal pain: case report and literature review

BACKGROUND: Duodenal diverticulum is a little-known pathology. The duodenum represents second place in frequency for the presence of diverticula in the digestive tract after the colon. Duodenal diverticulum as a cause of hemorrhage of the upper gastrointestinal (GI) tract has been described as an infrequent complication, although it must be considered in patients with digestive hemorrhage without evident cause at the esophagogastric level. Localization of diverticula in the third or fourth portions of the duodenum is rare and the diverticula are asymptomatic in 90% of cases. Diagnosis is made by endoscopy, contrast X-rays of the upper GI tract, selective arteriography and as a transoperative finding. The objective of this study was to identify and analyze the clinical presentation of duodenal diverticulum to familiarize surgeons and gastroenterologists when there is suspicion of the diagnosis. CLINICAL CASE: We report the case of an 85-year-old female presenting with massive upper GI tract hemorrhage and chronic abdominal pain due to a duodenal diverticulum located in the third portion of the duodenum. Diagnosis was made with upper GI barium series because visualization of the diverticulum was not possible by endoscopy. Other therapeutic options are described in the literature. A successful simple diverticulectomy, manually opened with a two-plane transversal incision, was performed on the patient. After >12 months of follow-up, the patient is completely asymptomatic. DISCUSSION: Clinical diagnosis presents difficulty because a classic presentation does not exist. Symptoms are generally vague, <10% of the duodenal diverticulum are frankly symptomatic, and <1 to 2% will require surgical resolution. CONCLUSIONS: Hemorrhage of the upper GI tract and chronic abdominal pain secondary to duodenal diverticulum present with recurrence and may be associated with the presence of duodenal diverticulum when other sources of bleeding are not found.

Casos quirúrgicos relavantes: divertículo esofágico: reporte de un caso / Relevant surgical caso: esophageal diverticulum: case report

Los divertículos del esófago, son una patología poco frecuente, por lo que el cirujano tendrá la oportunidad de observar pocos durante su carrera. La incidencia de esta entidad, dentro de la afección quirúrgica del esófago, se calcula alrededor del 2.7%. (1). Se presenta el caso de un paciente con un divertículo esofágico verdadero por tracción, tratado en el Hospital General San Juan de Dios.

Paradoxical Air Embolism during Percutaneous Nephrolithotomy: A Case Report

Air embolism is a rare complication of percutaneous nephrolithotomy. Patent foramen ovale, which is necessary in fetal circulation, is a potential route for emboli arising from the venous system to enter the systemic arterial circulation, resulting in paradoxical air embolism syndrome. A case of paradoxical air embolism during percutaneous nephrolithotomy is presented. To our knowledge, this is the first report of paradoxical air embolism associated with patent foramen ovale during percutaneous nephrolithotomy.

Divertículo ventricular congênito associado à taquicardia ventricular / Congenital ventricular diverticulum associated with ventricular tachycardia

Divertículos ventriculares congênitos são raros. Clinicamente, podem ser assintomáticos ou causa de embolização sistêmica, insuficiência cardíaca, insuficiência valvar, ruptura ventricular, arritmia ventricular ou morte súbita. Apresentamos caso de uma mulher de 56 anos com taquicardia ventricular sustentada, na qual, durante a investigação, foi diagnosticada a presença de um divertículo na posição ínfero-basal do ventrículo esquerdo. Comentam-se as características clínicas e o tratamento desta doença infreqüente.