Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and es...Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.展开更多
BACKGROUND While diverticular disease is prevalent in the West,the formation of giant colonic diverticula is rare.To date,approximately 200 cases have been reported,with only a handful treated surgically using a minim...BACKGROUND While diverticular disease is prevalent in the West,the formation of giant colonic diverticula is rare.To date,approximately 200 cases have been reported,with only a handful treated surgically using a minimally invasive approach.Furthermore,the natural history of giant colonic diverticula is not well documented.CASE SUMMARY This report describes the case of a 66-year-old man who developed a giant colonic diverticulum with primary symptoms including dull and chronic pain in the right lower quadrant at presentation.The patient had undergone several computed tomography scans of the abdomen and pelvis over the previous two years,through which the natural history of this rare entity could be retrospectively observed.The patient was successfully treated with a robot-assisted sigmoid colectomy and had an uneventful recovery with resolution of symptoms during the follow-up.CONCLUSION This rare case demonstrates the natural history of giant colonic diverticulum formation and supports the feasibility of robot-assisted surgery.展开更多
BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been ...BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been reported world-wide.In children,the clinical symptoms are similar to appendicitis.As most of the imaging features are nonspecific,the preoperative diagnosis is not precise.In addition,the clinical characteristics are highly similar to pediatric acute appendicitis,thus special attention is necessary to distinguish Meckel’s diver-ticulum from pediatric appendicitis.Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications,including intestinal necrosis,intestinal perforation and gastrointestinal bleeding.CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction,which was caused by fibrous bands(ligaments)arising from the top part of Meckel's diverticulum,diverticular perforation,and diver-ticular inflammation.All three patients,aged 11-12 years,had acute appendicitis as their initial clinical presentation.All were treated by laparoscopic surgery with a favorable outcome.A complete dataset including clinical presentation,dia-gnostic imaging,surgical information,and histopathologic findings was also provided.CONCLUSION Preoperative diagnosis of Meckel’s diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children.Laparoscopy combined with laparotomy is useful for diagnosis and treatment.展开更多
BACKGROUND The study aimed to analyze the characteristic clinical manifestations of patients with intestinal disease Meckel’s diverticulum(MD)complicated by digestive tract hemorrhage.Moreover,we aimed to evaluate th...BACKGROUND The study aimed to analyze the characteristic clinical manifestations of patients with intestinal disease Meckel’s diverticulum(MD)complicated by digestive tract hemorrhage.Moreover,we aimed to evaluate the value of double-balloon enteroscopy(DBE)in MD diagnosis and the prognosis after laparoscopic diverticula resection.AIM To evaluate the value of DBE in the diagnosis and the prognosis after laparoscopic diverticula resection for MD with bleeding.METHODS The study retrospectively analyzed relevant data from 84 MD patients treated between January 2015 and March 2022 and recorded their clinical manifestations,auxiliary examination,and follow-up after laparoscopic resection of diverticula.RESULTS(1)Among 84 MD patients complicated with hemorrhage,77 were male,and 7 were female with an average age of 31.31±10.75 years.The incidence was higher in men than in women of different ages;(2)Among the 84 MD patients,65(78.40%)had defecated dark red stools,and 50(58.80%)had no accompanying symptoms during bleeding,indicating that most MD bleeding appeared a dark red stool without accompanying symptoms;(3)The shock index of 71 patients(85.20%)was<1,suggesting that the blood loss of most MD patients was less than 20%–30%,and only a few patients had a blood loss of>30%;(4)The DBE-positive rate was 100%(54/54),99mTcpertechnetate-positive scanning rate was 78%(35/45)compared with capsule endoscopy(36%)and small intestine computed tomography(19%).These results suggest that DBE and 99mTc-pertechnetate scans had significant advantages in diagnosing MD and bleeding,especially DBE was a highly precise examination method in MD diagnosis;(5)A total of 54 MD patients with hemorrhage underwent DBE examination before surgery.DBE endoscopy revealed many mucosal manifestations including normal appearance,inflammatory changes,ulcerative changes,diverticulum inversion,and nodular hyperplasia,with ulcerative changes being the most common(53.70%).This suggests that diverticular mucosal ulcer was the main cause of MD and bleeding;and(6)Laparoscopic dissection of diverticulae was performed in 76 patients,The patients who underwent postoperative follow-up did not experience any further bleeding.Additionally,follow-up examination of the 8 cases who had declined surgery revealed that 3 of them experienced a recurrence of digestive tract bleeding.These findings indicate that laparoscopic diverticula resection in MD patients complicated by bleeding had a favorable prognosis.CONCLUSION Bleeding associated with MD was predominantly observed in male adolescents,particularly at a young age.DBE was a highly precise examination method in MD diagnosis.Laparoscopic diverticula resection effectively prevented MD bleeding and had a good prognosis.展开更多
Pentalogy of Cantrell is a congenital anomaly characterized by a combination of birth defects involving the sternum,diaphragm,pericardium,abdominal wall,and heart.Pentalogy of Cantrell is a rare anomaly with high mort...Pentalogy of Cantrell is a congenital anomaly characterized by a combination of birth defects involving the sternum,diaphragm,pericardium,abdominal wall,and heart.Pentalogy of Cantrell is a rare anomaly with high mortality.This paper describes the treatment of a 9-month-old girl with pentalogy of Cantrell,pentalogy of Fallot,and left ventricular diverticulum.The patient is alive and well 13 years after surgery.展开更多
BACKGROUND Small bowel diverticula are rare in clinics,and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early.The true incidence of these diverticula may be underestimated due t...BACKGROUND Small bowel diverticula are rare in clinics,and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early.The true incidence of these diverticula may be underestimated due to their clinical symptoms not differing from those of small bowel obstruction resulting from other causes.It is common in the elderly,although it can occur at any age.CASE SUMMARY This is a case report of a 78-year-old man with epigastric pain for 5 d.Conservative treatment does not effectively relieve pain,inflammatory indicators are elevated,and computed tomography suggests jejunal intussusception and mild ischemic changes in the intestinal wall.Laparoscopic exploration showed that the left upper abdominal loop was slightly edematous,the jejunum mass at the near Flex ligament was palpable,the size was about 7 cm×8 cm,the local movement was slight,and the diverticulum was seen 10 cm downward,and the local small intestine was dilated and edema.Segmentectomy was performed.After the short parenteral nutrition after surgery,the fluid and enteral nutrition solution were pumped through the jejunostomy tube,and the patient was discharged after the treatment was stable,and the jejunostomy tube was removed in an outpatient clinic one month after the operation.Postoperative pathology:Jejunectomy specimen:(1)Small intestinal diverticulum with chronic inflammation,ulcer with full-thickness activity,and necrosis of the intestinal wall in some areas;(2)also see that the hard object is consistent with stone changes;and(3)the incision margin on both sides shows chronic inflammation of mucosal tissue.CONCLUSION Clinically,the diagnosis of small bowel diverticulum is difficult to distinguish from jejunal intussusception.Combined with the patient’s condition,rule out other possibilities after a timely disease diagnosis.According to the patient’s body tolerance adopt personalized surgical methods to achieve better recovery after surgery.展开更多
BACKGROUND Kommerell’s diverticulum(KD)with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it(35%of case study).There are three types of aortic arch ...BACKGROUND Kommerell’s diverticulum(KD)with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it(35%of case study).There are three types of aortic arch diverticulum.Even literature concerning the treatment options are limited.CASE SUMMARY We present a case report of a 50-year-old male with KD in the right aortic arch with aberrant left subclavian artery.We conducted a total endovascular repair procedure,which is innovative and will spread more light in the medical world.Our patient has no past medical history and is a non-smoker and non-alcoholic.Patient presented with shortness of breath,chest pain and dizziness for six months.Blood tests were done and computerized tomography(CT)angiogram of the chest confirmed the diagnosis,illustrating showed a 3.9 cm KD.On Day 1,the CT angiogram showed mild dilatation of the thoracic aorta,adjacent esophagus,trachea was compressed and displaced.Surgery was planned as the treatment modality.Carotid-Subclavian artery bypass and endovascular aortic repair was conducted.We used prolene 5-0 C1 sutures to precisely anastomose a 6-mm Dacron graft to the left subclavian artery.Haemostasis was secured and wounds were closed.Protamine was administered and patient was shifted to intensive care unit.Post-operative,patient responded favorably and was discharged.Regular follow-up is done.CONCLUSION The procedure we performed is novel.This will help the cardio-thoracic surgeons a better insight about the full procedures we conducted,thereby bringing more light and better treatment options in managing KD with aberrant subclavian artery.展开更多
目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)...目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)和双层缝合组(116例);另根据术后是否形成CSD将产妇分为CSD组(23例)和非CSD组(217例)。对比3层缝合组与双层缝合组产妇的临床特点,采用多因素Logistic回归分析CSD形成的独立影响因素并构建人工神经网络模型;采用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线进行模型验证。结果:①3层缝合组产妇的子宫肌层瘢痕厚度显著高于双层缝合组(7.06±2.09 mm vs.5.68±1.97 mm);而CSD形成情况(4.03%vs.15.52%)和憩室大小(0.36±0.09 ml vs.0.47±0.12 ml)则显著低于双层缝合组,差异均有统计学意义(P<0.05);②多因素分析示,子宫后屈、剖宫产次数≥2次、胎膜早破、围产期感染、剖宫产时机(择期)是影响CSD形成的独立危险因素(OR>1,P<0.05),而子宫肌层3层缝合是保护性因素(OR<1,P<0.05);③人工神经网络预测模型显示剖宫产次数、胎膜早破以及是否进行3层缝合所占权重均较高,经ROC曲线、校准曲线和临床决策曲线验证表明该模型预测能力良好。结论:CSD的形成与子宫后屈、剖宫产次数、胎膜早破、围产期感染、剖宫产时机等指标有关,临床应重点关注,此外,子宫肌层3层缝合可降低CSD的形成概率,在临床上值得推广应用。展开更多
文摘Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.
文摘BACKGROUND While diverticular disease is prevalent in the West,the formation of giant colonic diverticula is rare.To date,approximately 200 cases have been reported,with only a handful treated surgically using a minimally invasive approach.Furthermore,the natural history of giant colonic diverticula is not well documented.CASE SUMMARY This report describes the case of a 66-year-old man who developed a giant colonic diverticulum with primary symptoms including dull and chronic pain in the right lower quadrant at presentation.The patient had undergone several computed tomography scans of the abdomen and pelvis over the previous two years,through which the natural history of this rare entity could be retrospectively observed.The patient was successfully treated with a robot-assisted sigmoid colectomy and had an uneventful recovery with resolution of symptoms during the follow-up.CONCLUSION This rare case demonstrates the natural history of giant colonic diverticulum formation and supports the feasibility of robot-assisted surgery.
文摘BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been reported world-wide.In children,the clinical symptoms are similar to appendicitis.As most of the imaging features are nonspecific,the preoperative diagnosis is not precise.In addition,the clinical characteristics are highly similar to pediatric acute appendicitis,thus special attention is necessary to distinguish Meckel’s diver-ticulum from pediatric appendicitis.Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications,including intestinal necrosis,intestinal perforation and gastrointestinal bleeding.CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction,which was caused by fibrous bands(ligaments)arising from the top part of Meckel's diverticulum,diverticular perforation,and diver-ticular inflammation.All three patients,aged 11-12 years,had acute appendicitis as their initial clinical presentation.All were treated by laparoscopic surgery with a favorable outcome.A complete dataset including clinical presentation,dia-gnostic imaging,surgical information,and histopathologic findings was also provided.CONCLUSION Preoperative diagnosis of Meckel’s diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children.Laparoscopy combined with laparotomy is useful for diagnosis and treatment.
基金Supported by the Ten Thousand Doctor Plan in Yunnan Province,No.YNWR-MY-2018-020Yunnan Digestive Endoscopy Clinical Medical Center Foundation for Health Commission of Yunnan Province,No.2021LCZXXF-XH07,No.2021LCZXXF-XH15,and No.2022LCZXKF-XH17Yunnan Provincial Key Laboratory of Clinical Virology,No.202205AG070053-07.
文摘BACKGROUND The study aimed to analyze the characteristic clinical manifestations of patients with intestinal disease Meckel’s diverticulum(MD)complicated by digestive tract hemorrhage.Moreover,we aimed to evaluate the value of double-balloon enteroscopy(DBE)in MD diagnosis and the prognosis after laparoscopic diverticula resection.AIM To evaluate the value of DBE in the diagnosis and the prognosis after laparoscopic diverticula resection for MD with bleeding.METHODS The study retrospectively analyzed relevant data from 84 MD patients treated between January 2015 and March 2022 and recorded their clinical manifestations,auxiliary examination,and follow-up after laparoscopic resection of diverticula.RESULTS(1)Among 84 MD patients complicated with hemorrhage,77 were male,and 7 were female with an average age of 31.31±10.75 years.The incidence was higher in men than in women of different ages;(2)Among the 84 MD patients,65(78.40%)had defecated dark red stools,and 50(58.80%)had no accompanying symptoms during bleeding,indicating that most MD bleeding appeared a dark red stool without accompanying symptoms;(3)The shock index of 71 patients(85.20%)was<1,suggesting that the blood loss of most MD patients was less than 20%–30%,and only a few patients had a blood loss of>30%;(4)The DBE-positive rate was 100%(54/54),99mTcpertechnetate-positive scanning rate was 78%(35/45)compared with capsule endoscopy(36%)and small intestine computed tomography(19%).These results suggest that DBE and 99mTc-pertechnetate scans had significant advantages in diagnosing MD and bleeding,especially DBE was a highly precise examination method in MD diagnosis;(5)A total of 54 MD patients with hemorrhage underwent DBE examination before surgery.DBE endoscopy revealed many mucosal manifestations including normal appearance,inflammatory changes,ulcerative changes,diverticulum inversion,and nodular hyperplasia,with ulcerative changes being the most common(53.70%).This suggests that diverticular mucosal ulcer was the main cause of MD and bleeding;and(6)Laparoscopic dissection of diverticulae was performed in 76 patients,The patients who underwent postoperative follow-up did not experience any further bleeding.Additionally,follow-up examination of the 8 cases who had declined surgery revealed that 3 of them experienced a recurrence of digestive tract bleeding.These findings indicate that laparoscopic diverticula resection in MD patients complicated by bleeding had a favorable prognosis.CONCLUSION Bleeding associated with MD was predominantly observed in male adolescents,particularly at a young age.DBE was a highly precise examination method in MD diagnosis.Laparoscopic diverticula resection effectively prevented MD bleeding and had a good prognosis.
文摘Pentalogy of Cantrell is a congenital anomaly characterized by a combination of birth defects involving the sternum,diaphragm,pericardium,abdominal wall,and heart.Pentalogy of Cantrell is a rare anomaly with high mortality.This paper describes the treatment of a 9-month-old girl with pentalogy of Cantrell,pentalogy of Fallot,and left ventricular diverticulum.The patient is alive and well 13 years after surgery.
基金Supported by the Hubei Chen Xiaoping Science and Technology Development Foundation,No.CXPJJH12000002-2020035and Jiangsu Graduate Research and Practice Innovation Program,No.SJCX22_0742.
文摘BACKGROUND Small bowel diverticula are rare in clinics,and small intestinal obstruction caused by coprolites is rarer and difficult to diagnose early.The true incidence of these diverticula may be underestimated due to their clinical symptoms not differing from those of small bowel obstruction resulting from other causes.It is common in the elderly,although it can occur at any age.CASE SUMMARY This is a case report of a 78-year-old man with epigastric pain for 5 d.Conservative treatment does not effectively relieve pain,inflammatory indicators are elevated,and computed tomography suggests jejunal intussusception and mild ischemic changes in the intestinal wall.Laparoscopic exploration showed that the left upper abdominal loop was slightly edematous,the jejunum mass at the near Flex ligament was palpable,the size was about 7 cm×8 cm,the local movement was slight,and the diverticulum was seen 10 cm downward,and the local small intestine was dilated and edema.Segmentectomy was performed.After the short parenteral nutrition after surgery,the fluid and enteral nutrition solution were pumped through the jejunostomy tube,and the patient was discharged after the treatment was stable,and the jejunostomy tube was removed in an outpatient clinic one month after the operation.Postoperative pathology:Jejunectomy specimen:(1)Small intestinal diverticulum with chronic inflammation,ulcer with full-thickness activity,and necrosis of the intestinal wall in some areas;(2)also see that the hard object is consistent with stone changes;and(3)the incision margin on both sides shows chronic inflammation of mucosal tissue.CONCLUSION Clinically,the diagnosis of small bowel diverticulum is difficult to distinguish from jejunal intussusception.Combined with the patient’s condition,rule out other possibilities after a timely disease diagnosis.According to the patient’s body tolerance adopt personalized surgical methods to achieve better recovery after surgery.
文摘BACKGROUND Kommerell’s diverticulum(KD)with aberrant left subclavian artery is a rare congenital deformity and also has very little research literature about it(35%of case study).There are three types of aortic arch diverticulum.Even literature concerning the treatment options are limited.CASE SUMMARY We present a case report of a 50-year-old male with KD in the right aortic arch with aberrant left subclavian artery.We conducted a total endovascular repair procedure,which is innovative and will spread more light in the medical world.Our patient has no past medical history and is a non-smoker and non-alcoholic.Patient presented with shortness of breath,chest pain and dizziness for six months.Blood tests were done and computerized tomography(CT)angiogram of the chest confirmed the diagnosis,illustrating showed a 3.9 cm KD.On Day 1,the CT angiogram showed mild dilatation of the thoracic aorta,adjacent esophagus,trachea was compressed and displaced.Surgery was planned as the treatment modality.Carotid-Subclavian artery bypass and endovascular aortic repair was conducted.We used prolene 5-0 C1 sutures to precisely anastomose a 6-mm Dacron graft to the left subclavian artery.Haemostasis was secured and wounds were closed.Protamine was administered and patient was shifted to intensive care unit.Post-operative,patient responded favorably and was discharged.Regular follow-up is done.CONCLUSION The procedure we performed is novel.This will help the cardio-thoracic surgeons a better insight about the full procedures we conducted,thereby bringing more light and better treatment options in managing KD with aberrant subclavian artery.
文摘目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4~11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料,根据子宫肌层缝合方式的不同分为3层缝合组(124例)和双层缝合组(116例);另根据术后是否形成CSD将产妇分为CSD组(23例)和非CSD组(217例)。对比3层缝合组与双层缝合组产妇的临床特点,采用多因素Logistic回归分析CSD形成的独立影响因素并构建人工神经网络模型;采用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线进行模型验证。结果:①3层缝合组产妇的子宫肌层瘢痕厚度显著高于双层缝合组(7.06±2.09 mm vs.5.68±1.97 mm);而CSD形成情况(4.03%vs.15.52%)和憩室大小(0.36±0.09 ml vs.0.47±0.12 ml)则显著低于双层缝合组,差异均有统计学意义(P<0.05);②多因素分析示,子宫后屈、剖宫产次数≥2次、胎膜早破、围产期感染、剖宫产时机(择期)是影响CSD形成的独立危险因素(OR>1,P<0.05),而子宫肌层3层缝合是保护性因素(OR<1,P<0.05);③人工神经网络预测模型显示剖宫产次数、胎膜早破以及是否进行3层缝合所占权重均较高,经ROC曲线、校准曲线和临床决策曲线验证表明该模型预测能力良好。结论:CSD的形成与子宫后屈、剖宫产次数、胎膜早破、围产期感染、剖宫产时机等指标有关,临床应重点关注,此外,子宫肌层3层缝合可降低CSD的形成概率,在临床上值得推广应用。
