One-stage laparoscopy combined with resectoscope in the treatment of huge bladder diverticulum, multiple stones in diverticulum, multiple stones in bladder and benign prostatic hyperplasia: A case report.

Background: Bladder diverticulum is due to the abnormal arrangement of congenital bladder wall muscle fibers, weak limitations, combined with lower urinary tract obstruction, increased intravesical pressure, and protruding between the self-separated detrusor muscle bundles of the bladder wall. Giant bladder diverticulum refers to 10*8 cm or diverticulum over 150 ml in volume. Case summary: An 80-year-old male patient was admitted to our hospital on August 14, 2020, the preoperative diagnosis was: bladder diverticulum, bladder diverticulum calculi, multiple bladder stones and prostatic hyperplasia. On August 18, 2020, one-stage laparoscopic bladder diverticulectomy + diverticulum neck incision for stone removal + cystopuncture fistula + transurethral bladder stone removal + transurethral resection of the prostate (TURP) under general anesthesia. First, the bladder diverticulum was separated under laparoscopy, the diverticulum was incised, the diverticulum calculi were taken out, and then the diverticulum was completely removed, and the neck of the diverticulum was extended by 1.5 cm, and the large calculus of about 2.7*3.6 cm was completely removed, and then cystostomy + transurethral Bladder stone removal + TURP. There was no bleeding from the bladder suture during the operation. 200 ml of urine was drained from the extraperitoneal drainage tube, and 20 ml of urine was drained from the abdominal drainage tube during the operation, the urination is smooth, and the general condition can be discharged. The patient's general condition is good after follow-up. Conclusion: One-stage laparoscopic treatment of bladder diverticulectomy + diverticulum neck incision for stone extraction + cystopuncture fistula + transurethral bladder stone extraction + TURP surgery. There is no report at home and abroad, which can provide diagnosis and treatment ideas and surgical methods for urological colleagues to deal with such diseases.

Special Situations in the Management of Diverticular Disease.

Diverticular disease affects a large percentage of the US population, affecting over 30% among those older than 45 years old. It is responsible for ∼300,000 hospitalizations per year in the United States and can lead to serious complications such as hemorrhage, obstruction, abscess, fistulae, or bowel perforation. 2 It is an extremely common reason for emergency room and outpatient visits and evaluations by general and colorectal surgeons. In the US, patients usually present with sigmoid diverticulitis in the setting of a normal immune system so surgeons will follow well-established practice guidelines for treatment. However, there may be special circumstances in which the management of diverticulitis is not as straightforward. In this article, we will address patients who present with multifocal disease, giant colonic diverticulum, right-sided diverticulitis, and diverticulitis in the setting of immunosuppression and hopefully provide guidance for treatment in these special circumstances.

[Laparoscopic resection of a giant colon diverticulum : Case report and review of the literature]. / Laparoskopische Resektion eines Riesenkolondivertikels : Fallbericht und Literaturübersicht.

BACKGROUND: Giant diverticula are rare complications of diverticular disease. Current opinion regards operative therapy as the method of choice for the treatment of symptomatic giant diverticula; however, there is neither consensus about the technique nor about the necessary extent of resection. Based on a non-systematic review of the literature, an overview of giant diverticula in terms of epidemiology, pathology and classification is given. The current case is considered with respect to appropriate diagnostic procedures and possible therapeutic options. CASE PRESENTATION: An 80-year-old female patient presented to the emergency department with abdominal pain and dyspnea. A computed tomography scan showed a large gas-filled structure in the upper left abdomen adjacent to the left colon. A giant colonic diverticulum was suspected and laparoscopy was performed. Intraoperatively, the diagnosis of a giant colon diverticulum located at the splenic flexure was confirmed. An unremarkable diverticulosis only was found in the descending colon. The giant diverticulum was treated by an atypical colon wedge resection and the postoperative course was uneventful. DISCUSSION: This case report describes a laparoscopic atypical colon wedge resection as treatment of a giant colon diverticulum. Only four laparoscopic bowel resections in terms of sigmoid resections or hemicolectomy with primary anastomosis have been reported. Minimally invasive surgery can be a valuable alternative to open procedures. In the current case a laparoscopic atypical colon wedge resection was safely performed. This option might be considered as an alternative to extended resections of giant diverticula. Localization of the giant diverticulum and the simultaneous existence of diverticular disease are the main criteria for the decision between the different operative approaches.

Giant diverticulum- A rare complication of a common surgical condition.

A gentleman presented with abdominal distension and pain. CT confirmed a 20 cm sigmoid diverticulum. A giant diverticulum, typified by diverticula greater than 4 cm, often requires colonic resection. Fewer than 200 cases have been reported, most measuring 7-15 cm. I present a rare complication of a common surgical condition with images.

Long segmental hyperplasia of interstitial cells of Cajal with giant diverticulum formation.

Sporadic gastrointestinal stromal tumors (GISTs) usually form a well-circumscribed mass. In contrast, diffuse interstitial cell of Cajal (ICC) hyperplasia along the Auerbach plexus without a discrete mass may occur in patients with germline mutations in the NF1, c-KIT or PDGFRA genes. However, sporadic, diffuse ICC hyperplasia without c-KIT or PDGFRA mutations has not been reported. We describe herein one such case, forming a giant diverticulum. A 63-year-old woman with no features of Neurofibromatosis 1 (NF1) presented with increasing abdominal pain for more than 30 years. A large, diverticulum-like mass in the ileum was resected. Microscopically, a diffuse proliferation of bland spindle cells was seen extending for 12 cm, replacing the muscularis propria and lined by intact mucosa. The spindle cells were CD117+/CD34+/DOG1+/SMA+/Desmin-/S100-. Mutation analyses did not reveal any mutations in c-KIT or PDGFRA. The lesion had two silent mutations in the NF1 gene. It is rare of the diffuse form of sporadic ICC hyperplasia showing diffuse longitudinal microscopic growth completely replacing the muscularis propria, mimicking diffuse ICC hyperplasia in hereditary GIST syndromes, but without solid components and no c-KIT or PDGFRA gene mutations. This peculiar form of sporadic ICC hyperplasia may be related to intestinal dysmotility in this ileal segment and giant diverticulum formation.

Pattern and distribution of colonic diverticulosis: analysis of 2877 barium enemas in Thailand.

AIM: To determine the pattern and distribution of colonic diverticulosis in Thai adults. METHODS: A review of the computerized radiology database for double contrast barium enema (DCBE) in Thai adults was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded. The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined. The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were reported. Factors influencing the presence of colonic diverticulosis were evaluated. RESULTS: A total of 2877 suitable DCBE examinations were retrospectively reviewed. The mean age of patients was 59.8 ± 14.7 years. Of these patients, 1778 (61.8%) were female and 700 (24.3%) were asymptomatic. Colonic diverticulosis was identified in 820 patients (28.5%). Right-sided diverticulosis (641 cases; 22.3%) was more frequently reported than left-sided diverticulosis (383 cases; 13.3%). Pancolonic diverticulosis was found in 98 cases (3.4%). The occurrence of solitary cecal diverticulum, rectal diverticulum and giant diverticulum were 1.5% (42 cases), 0.4% (12 cases), and 0.03% (1 case), respectively. There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients (28.3% vs 28.6%, P = 0.85). DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals (29.5% vs 25.3%, P = 0.03). Change in bowel habit was strongly associated with the presence of diverticulosis (a relative risk of 1.39; P = 0.005). The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals (P > 0.05). CONCLUSION: Colonic diverticulosis was identified in 28.5% of DCBE examinations in Thai adults. There was no association between the presence of diverticulosis and gender or age.

Giant Diverticulum of the Duodenum.

A 50-year old female presented herself with abdominal bloating and pain in the Emergengy Department. The symptoms persisted and a clinical evaluation was made. A lesion suspect for a giant duodenal diverticulum was seen on the CT-scan, which was confirmed by enteroclysis. Surgical resection was performed. The diagnosis was histological confirmed after surgery. Small bowel diverticula are relatively common, with an estimated 5 - 22% incidence in the healthy population. They are usually asymptomatic, but can present with abdominal pain and weight loss. Complications such as bleeding and perforation can occur. Surgical resection is the treatment of choice in symptomatic patients.

Divertículo gigante do cólon: uma doença rara com localização atípica / Giant colonic diverticulum, a rare disease with atypical localization

O divertículo gigante do cólon é uma rara patologia com menos de 150 casos descritos na literatura inglesa, sendo a primeira referência feita pelos franceses Bonvin e Bonte em 1946. Em 90% dos casos, esta patologia localiza-se no cólon sigmoide e a sua apresentação pode variar desde a forma assintomática até o abdômen agudo. O caso descrito ocorreu em um paciente masculino, com 55 anos, e apresentou-se insidiosamente, com quadro clínico infeccioso e diagnóstico realizado por ressonância nuclear magnética e enema opaco. A localização do divertículo é atípica no cólon transverso, e o tratamento realizado foi cirúrgico com diverticulectomia, apresentando pós-operatório sem complicações.

Giant colonic diverticulum is a rare disease with fewer than 150 cases reported in English literature, the first reference made by the French Bonvin and Bonte in 1946. In 90% of cases the pathology is located in the sigmoid colon and the presentation of this disease can vary from asymptomatic to the acute abdomen. The case described occurred in a male patient aged 55 years and presented insidiously with clinical infection and diagnosis by MRI and barium enema. The location of divertículo is atypical in the transverse colon, and the patient was treated with surgical diverticulectomy, with no postoperative complications.

Giant Transverse Colon Diverticulitis Presenting as Indirect Right Inguinal Hernia Strangulation

A giant colonic diverticulum is a rare complication of diverticulosis, and an inguinal hernia is a common diagnosis for patients presenting with a painful groin mass. A 52-year-old male presented to the emergency room with a 3-hour complaint of progressive, constant, right-groin pain with an inguinal mass. After manual reduction of the inguinal hernia, the patient complained of pain in the right upper quadrant. Operative findings showed a transverse colon diverticulitis without perforation. We report here that case of a transverse colon giant diverticulum presenting as an atypical incarcerated inguinal hernia.