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Morris PD, Allaway MGR, Mwagiru DK, Sinclair JLB, Hollands M. Gastric diverticulum: a contemporary review and update in management. ANZ J Surg 2023; 93:2828-2832. [PMID: 37743578 DOI: 10.1111/ans.18707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Gastric diverticula (GD) are the rarest form of gastrointestinal tract diverticulum, with an estimated incidence of 0.013-2.6%. GD are poorly understood and there are no established management guidelines. Only sparse updates have been published since the mid-20th century. This paper reviews the current literature and provides some suggested guidelines for the management of GD. METHODS A search of Medline via OvidSP and Google Scholar for 'gastric diverticulum' and associated synonyms from the year 1950 onwards was performed. We included randomized controlled trials (RCTs), cohort and case-control studies, and case series. Full text, English language manuscripts on adult populations were included. RESULTS A total of 103 manuscripts were included in the final selection - 77 individual case studies, 23 case series and three reviews. No RCTs, cohort or case-control studies were found. The case studies represent 305 patients, 50.8% female with average age 49.2 years (range 18-80). The most common symptom was abdominal pain (48.2%). The average maximum diameter was 3.97 cm (range 0.5-9). One hundred and four patients were managed operatively. Despite persistent recommendations in the literature that GD > 4 cm should be considered for resection, there are no data supporting this approach. CONCLUSION The evidence pertaining to the management of GD is sparse. The decision for operative management should be individualized and based primarily on the presence of symptoms or complications which may be directly attributable to the GD. Where surgery is indicated, a laparoscopic approach, potentially with intra-operative gastroscopy, is appropriate.
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Affiliation(s)
- Paul David Morris
- Department of Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, Western Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew G R Allaway
- Department of Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- School of Medicine, Blacktown & Mount Druitt Medical School, Western Sydney University, Blacktown, New South Wales, Australia
| | - Derek Kamenju Mwagiru
- Department of Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jane-Louise B Sinclair
- Department of Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Michael Hollands
- Department of Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, Western Clinical School, University of Sydney, Sydney, New South Wales, Australia
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2
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Bodh V, Sharma R, Sharma B, Ahluwalia A, Kumar R. Gastroduodenal fistula or double pylorus: Case report of a rare finding. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2021. [DOI: 10.4103/cjhr.cjhr_177_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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SÖNMEZ TOPCU F, KOC U. Gastric Diverticulum in Computed Tomography. TURKISH JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.46310/tjim.772179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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4
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Gastric heterotopic pancreas in children: A prospective endoscopic study. J Pediatr Surg 2020; 55:2154-2158. [PMID: 31757509 DOI: 10.1016/j.jpedsurg.2019.10.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To document the prevalence and variable appearance of gastric heterotopic pancreas (HP) in children undergoing upper gastrointestinal (GI) endoscopy. METHODS A prospective 4-year study of children undergoing flexible upper GI endoscopy in a single institution. RESULTS A total of 607 upper GI endoscopies were performed in 478 pediatric patients during the 4-year period. Eleven children (6 girls, 5 boys) aged 2.9 to 16.9 years had endoscopic features typical of gastric HP. All but one lesion was located in the gastric antrum and most appeared as an umbilicated submucosal nodule measuring 1-2 cm in diameter. Five of 13 children with repaired esophageal atresia (EA) and two of nine children with trisomy 21 had gastric HP. The prevalence of endoscopically visualized gastric HP in children without a history of EA or trisomy 21 was 1.1%. CONCLUSIONS Gastric HP is present in about 1% of pediatric upper GI endoscopies. It is significantly more common in patients with EA and may also be associated with trisomy 21. Gastric HP typically appears as a single 1-2 cm antral submucosal nodule, usually with a central pit. Recognition of this lesion is important to avoid misdiagnosis and inappropriate treatment. LEVEL OF EVIDENCE Level II (diagnostic).
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Subedi A, Achufusi TG, Jessamy K, Sapkota B. Double pylorus in cirrhosis. Proc (Bayl Univ Med Cent) 2020; 33:639-640. [DOI: 10.1080/08998280.2020.1798731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Abinash Subedi
- Department of Internal Medicine, State University of New York Upstate Medical University, Syracuse, New York
| | - Ted George Achufusi
- Department of Internal Medicine, State University of New York Upstate Medical University, Syracuse, New York
| | - Kegan Jessamy
- Division of Gastroenterology, State University of New York Upstate Medical University, Syracuse, New York
| | - Bishnu Sapkota
- Division of Gastroenterology, State University of New York Upstate Medical University, Syracuse, New York
- Division of Gastroenterology, Veterans Affairs Medical Center, Syracuse, New York
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Seyyedmajidi M, Shajari R, Vafaeimanesh J. An Interesting Finding in Upper Gastrointestinal Endoscopy. Middle East J Dig Dis 2020; 12:130-132. [PMID: 32626568 PMCID: PMC7320992 DOI: 10.34172/mejdd.2020.174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mohammadreza Seyyedmajidi
- Golestan Research Center of Gastroenterology and Hepatology-GRCGH, Golestan University of Medical Sciences, Gorgan, Iran
| | - Rasoul Shajari
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Ira
| | - Jamshid Vafaeimanesh
- Clinical Research Development Center, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Ira.,Gastroenterology and Hepatology disease Research Center, Qom University of Medical Sciences, Qom, Iran
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Shah J, Patel K, Sunkara T, Papafragkakis C, Shahidullah A. Gastric Diverticulum: A Comprehensive Review. Inflamm Intest Dis 2019; 3:161-166. [PMID: 31111031 PMCID: PMC6501548 DOI: 10.1159/000495463] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/13/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gastric diverticula (GD) are outpouchings of the stomach wall that typically form in the fundus. They are the least common gastrointestinal diverticula, and are very rare anatomic abnormalities overall. SUMMARY Although most GD are asymptomatic and are usually discovered incidentally during routine diagnostic testing, they can present with variable symptoms. Occasionally, complications can develop that may be life-threatening and are indications for surgical management. KEY MESSAGES Here, we provide a literature review of GD where we discuss the pathogenesis, clinical manifestations, investigations and diagnostic approach, and various management options for this uncommon disorder.
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Affiliation(s)
- Jamil Shah
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, University Hospital, Newark, New Jersey, USA
| | - Kalpesh Patel
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, University Hospital, Newark, New Jersey, USA
| | - Tagore Sunkara
- Department of Gastroenterology, Mercy Medical Center, Des Moines, Iowa, USA
| | | | - Abul Shahidullah
- Department of Medicine, Henry J. Carter Specialty Hospital and Nursing Facility, New York, New York, USA
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Fousekis F, Aggeli P, Kotsaftis P, Pappas-Gogos G. Double Pylorus: Report of a Case With Endoscopic Follow-Up and Review of the Literature. Gastroenterology Res 2018; 11:154-156. [PMID: 29707084 PMCID: PMC5916641 DOI: 10.14740/gr960w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/08/2018] [Indexed: 12/27/2022] Open
Abstract
Double pylorus is a rare endoscopic finding that has been reported in 0.001% to 0.4% of upper gastrointestinal endoscopies and can be either congenital or acquired. Acquired double pylorus is usually an uncommon complication of peptic ulcer that erodes and creates a fistula between the duodenal bulb and the prepyloric antrum. We describe a case of a 67-year-old man who experienced mild epigastric pain and dyspepsia over the last 6 months. The patient periodically took nonsteroidal anti-inflammatory drugs (NSAIDs) due to joint pain. Esophagogastroduodenoscopy revealed gastritis and a double pylorus. An accessory channel connected the lesser curvature of the prepyloric antrum to the duodenal bulb and the endoscope was able to be passed through both of the ducts. The Helicobacter pylori quick test proved positive. Two years later, a follow-up endoscopy showed that fistula fused with normal pylorus and there was a single large opening.
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Affiliation(s)
- Fotios Fousekis
- Department of Gastroenterology and Endoscopy Unit, Filiates General Hospital, Filiates, Greece
| | - Panagiota Aggeli
- Department of Gastroenterology and Endoscopy Unit, Filiates General Hospital, Filiates, Greece
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9
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Umar S, Bilal M. Double pylorus: two sides to one story. Clin Case Rep 2016; 4:1211-1212. [PMID: 27980768 PMCID: PMC5134144 DOI: 10.1002/ccr3.730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 09/04/2016] [Accepted: 09/28/2016] [Indexed: 12/05/2022] Open
Abstract
It is important to recognize that “congenital” double pylorus is a benign condition, so that extensive work‐up can be avoided. Also, endoscopists should be aware of the double pylorus and demonstrate extra caution during endoscopic retrograde cholangiopancreatography (ERCP).
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Affiliation(s)
- Shifa Umar
- Department of Internal Medicine Allegheny General Hospital Pittsburgh Pennsylvania USA
| | - Mohammad Bilal
- Department of Internal Medicine Allegheny General Hospital Pittsburgh Pennsylvania USA
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10
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Yuan XY, Huang YQ. Congenital double pylorus with duodenal ulcer: A case report and review of the literature. Shijie Huaren Xiaohua Zazhi 2016; 24:4024-4028. [DOI: 10.11569/wcjd.v24.i28.4024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Congenital double pylorus (CDP) is an extremely rare congenital disease in which both the prosopyle and apopyle are intercommunicated with the gastric antrum and duodenal bulb. The pylorus of CDP is composed of normal mucous epithelium, the lamina propria, and the muscularis mucosae. However, a few CDP operations have proved the lack of the muscularis mucosae but the existence of heterotopic pancreas tissues in the pylorus of CDP. This article reports a case of CDP complicated with duodenal ulcer in a 67-year-old man. He presented with repeated epigastric pain for 8 years and melena for 6 years, with recurrence for 3 d. He was positive for Helicobacter pylori (H. pylori) antibody. Gastroendoscopy performed 8 years ago revealed double pylorus, bile reflux gastritis, and duodenal bulbar inflammation. Gastroendoscopy performed 6 years ago revealed double pylorus with a duodenal bulbar ulcer lesion, and pathological examination suggested chronic inflammation in the duodenal bulbar mucosa, accompanied with low grade gland dysplasia. A second gastroendoscopy performed 6 years ago also revealed double pylorus with a duodenal bulbar ulcer (A2 stage). Gastroendoscopy at our hospital revealed double pylorus and pyloric canal inflammation, and pathological examination suggested pyloric canal mucosal inflammation accompanied with erosion and mild intestinal metaplasia. He was then given proton pump inhibitor therapy combined with anti-H. pylori therapy, and his symptoms were obviously improved. This case suggests that gastroendoscopy is the most direct and accurate method for the diagnosis of CDP.
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11
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Syncope with Surprise: An Unexpected Finding of Huge Gastric Diverticulum. Case Rep Surg 2016; 2016:1941293. [PMID: 27313940 PMCID: PMC4899588 DOI: 10.1155/2016/1941293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 02/04/2023] Open
Abstract
A gastric diverticulum is a pouch protruding from the gastric wall. The vague long clinical history ranging between dyspepsia, postprandial fullness, and upper gastrointestinal bleeding makes this condition a diagnostic challenge. We present a case of large gastric diverticulum that has been diagnosed during clinical investigations for suspected cardiovascular issues in a patient admitted at the medical ward for syncope. A 51-year-old man presented to the medical department due to a syncopal episode occurring while he was resting on the beach after having his lunch, with concomitant vague epimesogastric gravative pain without any other symptom. A diagnosis of neuromediated syncopal episode was made by the cardiologist. Due to the referred epimesogastric pain, an abdominal ultrasound scan was carried out, showing perisplenic fluid. A CT scan of the abdomen was performed to exclude splenic lesions. The CT scan revealed a large diverticulum protruding from the gastric fundus. The upper gastrointestinal endoscopy visualized a large diverticular neck situated in the posterior wall of the gastric fundus, partially filled by undigested food. The patient underwent surgery, with an uneventful postoperative course. Histologic examination showed a full-thickness stomach specimen, indicative of a congenital diverticulum. At the 2nd month of follow-up, the patient was asymptomatic.
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12
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Lei JJ, Zhou L, Liu Q, Xu CF. Acquired double pylorus: Clinical and endoscopic characteristics and four-year follow-up observations. World J Gastroenterol 2016; 22:2153-2158. [PMID: 26877621 PMCID: PMC4726689 DOI: 10.3748/wjg.v22.i6.2153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/16/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Double pylorus (DP), or duplication of the pylorus, is an uncommon condition that can be either congenital or acquired. Acquired DP (ADP) occurs when a peptic ulcer erodes and creates a fistula between the duodenal bulb and the distal stomach. The clinical features and endoscopic characteristics of four patients with ADP were reviewed and compared with previously reported cases. An accessory channel connects the lesser curvature of the prepyloric antrum with the duodenal bulb, and in all cases, a peptic ulcer was located in or immediately adjacent to the accessory channel. In one of the patients, the bridge between the double-channel pylorus disappeared, resulting in a single large opening and duodenal kissing ulcer after two years and three months. Finally, nonsteroidal anti-inflammatory drugs, Helicobacter pylori and other risk factors associated with ADP are assessed.
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13
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Chen QY, Chen Y, Liang, Wang J, Du Q, Cai JT, Chen JM. Acquired double pylorus: a case report. ASIAN PAC J TROP MED 2012; 5:503-4. [PMID: 22575987 DOI: 10.1016/s1995-7645(12)60087-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/15/2012] [Accepted: 04/15/2012] [Indexed: 10/28/2022] Open
Abstract
Double pylorus is one of the rare anomalies of the gastrointestinal tract, it can be congenital or acquired. In this case we report a case of double pylorus because of chronic peptic ulcer. Upper GI endoscopy revealed gastroduodenal fistula located on the lesser curve of the antrum, the patient's symptoms were improved rapidly by intensive antiulcer treatment.
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Affiliation(s)
- Qing-Yu Chen
- Department of Gastroenterology, Second Affiliated Hospital, Zhe Jiang University College of Medicine, China
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Rashid F, Aber A, Iftikhar SY. A review on gastric diverticulum. World J Emerg Surg 2012; 7:1. [PMID: 22257431 PMCID: PMC3287132 DOI: 10.1186/1749-7922-7-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 01/18/2012] [Indexed: 11/24/2022] Open
Abstract
The gastric fundal diverticulae are rare. They can present with variable symptoms. We are enclosing a literature review on gastric fundal diverticulum. Lessons have emerged which may help in the management of this rare condition in future.
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Affiliation(s)
- Farhan Rashid
- Department of Upper GI Surgery, Royal Derby Hospital, Graduate Entry Medical School, Derby, University of Nottingham, UK.
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Goitein D, Papasavas PK, Gagné DJ, Urbandt J, Caushaj PF. Laparoscopic resection of gastric diverticulum presenting after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006; 2:528-30. [PMID: 17015206 DOI: 10.1016/j.soard.2006.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Revised: 05/27/2006] [Accepted: 06/05/2006] [Indexed: 11/16/2022]
Abstract
Gastric diverticula are extremely rare and may be congenital or acquired. Postgastrectomy formation of gastric diverticula has been attributed to outpouching through the weakened wall of the stomach. When symptomatic, gastric diverticula may cause pain, nausea, dysphagia, and vomiting. Gastric diverticula may also be associated with ectopic mucosa, ulcers, and neoplastic changes. We report a case of gastric cardia diverticulum that became symptomatic after laparoscopic Roux-en-Y gastric bypass. The patient was successfully treated with laparoscopic resection.
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Affiliation(s)
- David Goitein
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Akazawa Y, Mizuta Y, Osabe M, Nakamura T, Morikawa S, Isomoto H, Takeshima F, Kohno S, Murata I. A case of double pylorus caused by recurrent gastric ulcers: a long-term endoscopic observation. Dig Dis Sci 2005; 50:2125-8. [PMID: 16240226 DOI: 10.1007/s10620-005-3018-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 02/03/2005] [Indexed: 12/16/2022]
Affiliation(s)
- Yuko Akazawa
- Department of Internal Medicine, Omura Municipal Hospital, Nagasaki, Japan.
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