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Gastroenterology
Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021
This patient has a Zenker’s diverticulum, a diverticulum of the mucosa of the pharynx (about the cricopharyngeal muscle). Consequently, the most beneficial investigation is a barium swallow. If the diverticulum is small and asymptomatic it may be treated conservatively. However, if the diverticulum is larger it may be resected by either open or endoscopic surgery.
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
In the paediatric population 95% of diverticulum presenting with bleeding will contain ectopic gastric mucosa and scintigraphy is most sensitive in this population. CT angiogram is of limited value and also radiation dose would need to be considered in a paediatric patient. Identifying a diverticulum with ultrasound can be challenging and similar to small bowel fluoroscopy, and cannot confidently exclude the diagnosis. Angiography may be employed; however, it would not typically be a first-line investigation.
Fabry disease
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
Gastrointestinal manifestations may be prominent [26]. In some patients, they may be the only complaints for years. There may be postprandial pain or diarrhea. Infiltration of autonomic nerve cells and mucosal cells with lipid may interfere with peristalsis. Diverticula may develop, and rupture of a diverticulum is a surgical emergency.
Endoscopic characteristics of Meckel’s diverticulum in adults: a retrospective case-series from two tertiary general hospitals in China
Published in Scandinavian Journal of Gastroenterology, 2023
Jing Yang, Zhitao Chen, Yan Fan, Lei Zhou, Qingqing Tian, Xin Yin, Xiaowei Jin, Heng Zhang, Shoubin Ning
Double-balloon enteroscopy (Fujinon EN-450T5, Fujinon Inc., Japan) was used in 24 patients while 42 patients underwent the BAE examination taking the single-balloon enteroscopy (Olympus SIF-Q260, Olympus Inc., Japan). Considering that DBE and SBE had comparable diagnostic performance for small bowel diseases [10,11], the choice of BAE type depended on the facilities of the two hospitals and the preference of endoscopists. Endoscopic detection of double-lumen sign in the ileum (Figure 1) and/or intraluminal contemporaneous ulcerative lesions [4–6] were used to diagnose MD. On diagnosing MD, we scrutinized two lumens to distinguish between the diverticulum and the ileum. Moreover, we used biopsy forceps to measure the long diameter of the MD orifice and the depth of the whole diverticulum (Figure 2). The location of MD is denoted by the distance to the ileocecal valve. The small bowel upstream of the diverticulum was observed as much as possible.
The effects of hysteroscopy and laparoscopy for scar diverticulum resection and suture on blood loss, operation time and antibiotic time
Published in Journal of Obstetrics and Gynaecology, 2022
Weifeng Li, Tiecheng Lin, Yong Xie, Lijiang Xu, Yangping Chen, Yuyuan Zhu, Xia Dong, Pei Cheng, Chunxiang Duan
Uterine scar diverticulum (CSD) after caesarean section, also called postoperative uterine incision defect (PCSD), is caused by poor healing of the uterine incision after caesarean section, manifested as thinning of the muscle layer at the incision of the uterine scar. The depression or cavity in communication with the uterine cavity will then cause abnormal vaginal bleeding, pelvic pain and other related clinical symptoms (Minovi et al. 2015; Zhao et al. 2019). Uterine diverticulum is divided into congenital and acquired diverticulum. Congenital diverticulum is related to abnormal embryonic development. Acquired diverticulum is also called false diverticulum. Uterine incision diverticulum after caesarean section is an acquired diverticulum. In recent years, with the increase of caesarean section, acquired uterine diverticulum has gradually increased. Patients with uterine diverticulum often present with prolonged menstrual period, inexhaustible vaginal bleeding, and pregnancy in the diverticulum. Its treatment included drugs and surgery. At present, there is no unified understanding of the effects of various treatment methods, and a unified treatment standard has not been formed. This study intends to investigate the role of transvaginal CSD electro resection and suture guided by hysteroscopy in the treatment of CSD.
Colorectal resection in end-stage renal disease (ESRD) patients: experience from a single tertiary center
Published in Acta Chirurgica Belgica, 2022
Julie Frezin, Julie Navez, Paryse Johnson, Philippe Bouchard, Sébastien Drolet
Concerning diverticular disease, our study included a few patients operated for diverticulitis (n = 12). There was no difference in morbidity and mortality between elective and emergency surgery. However, the rate of ostomy was higher in the emergency surgery group. Moran-Atkin et al. [18] compared 834 ESRD patient operated in emergency for diverticulitis with 161 ESRD patients who beneficiated from elective surgery. The two groups were matched for age categories, race, sex and period of admission. In-hospital mortality was not significantly different but overall morbidity, ostomy placement and LOS was higher in the emergency group. Compared to the general population, ESRD operated electively still had a 17.3 increased odd of mortality. Thus, indication for elective surgery after diverticulitis in ESRD patients should be individualized as it is still associated with high morbidity and mortality.