School of Medicine (Mr Lee) and Department of Surgery (Dr Perez), Duke University Medical Center, Duke University, Durham, North Carolina, USA.

ABSTRACT

Introduction: Gastric diverticulum is a rare condition that has been surgically managed in the past for a wide range of symptoms. These symptoms include nonspecific reflux, pain, abdominal bloating, dyspepsia, vomiting, and oral fetor, alongside more serious complications such as hemorrhage or malignancy. Although complications, such as hemorrhage or perforation, clearly indicate surgical intervention, the question of when to pursue diverticulectomy in the case of other milder and persistent symptoms is still unclear. In the case of oral fetor, three previous case reports indicated complete resolution after diverticulectomy.

Case Description: A 65-year-old man with longstanding halitosis underwent an extensive workup including endoscopy, computed tomography (CT) of the abdomen and pelvis, and barium swallow. He was found to have a large gastric diverticulum and elected to undergo resection. There was no significant intraoperative blood loss, and postoperative recovery was uneventful. However, the patient continued to experience persistent oral fetor 5 months after the diverticulectomy and returned to previously used conservative measures, such as peppermint and chlorophyll.

Conclusion: Given the subjective nature of what a patient considers to be resolution of halitosis, our report presents an argument for conservative management of gastric diverticulum, even after alternative causes of halitosis have been investigated.

Key Words: Diverticulum, Halitosis, Laparoscopy, Stomach.

The post Indications for Surgical Resection of the Gastric Diverticulum first appeared on JSLS.

School of Medicine (Mr Anderson) and Department of Surgery (Drs Pappas and Perez), Duke University Medical Center, Duke University, Durham, North Carolina, USA.
Department of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada (Dr. Rialon).

ABSTRACT

Introduction: Duodenal duplication cysts are rare congenital malformations that are most often identified incidentally and managed nonoperatively. Because of the location of the cyst, it can obstruct the biliopancreatic ampulla requiring operative intervention. An open surgical approach is the conventional procedure for these patients.

Case Descriptions: Since 1990, our institution has resected 3 duodenal duplication cysts. Symptomatic 15- and 17-year-olds underwent open resection of duplication cysts. Most recently, a 25-year-old woman presented with recurring pancreatitis and was subsequently diagnosed with a duodenal cyst on computed tomographic scan and endoscopic ultrasonography. The patient was taken to the operating room for laparoscopic excision. Operative time for the laparoscopic approach was 2 hours and 45 minutes, with no significant intraoperative blood loss. Postoperative recovery was uneventful in all cases.

Discussion: After identification of appropriate operative candidates, laparoscopic resection for duodenal duplication cysts is a feasible procedure that provides smaller incisions and decreased blood loss.

Key Words: Duodenal duplication cyst, Laparoscopic resection, Laparoscopy, Surgical treatment.

The post Evolution of Surgical Resection for Duodenal Duplication Cyst first appeared on JSLS.