Authors: J. Pažin; Š. O. Schütz; P. Kolek; Radek Pohnán Authors‘ workplace: 2. LF UK a ÚVN – VFN Praha ; Chirurgická klinika Published in: Rozhl. Chir., 2025, roč. 104, č. 12, s. 549-554. Category: Case Report doi: https://doi.org/10.48095/ccrvch2025549
Introduction: Gastric diverticulum is a very rare condition and, in most cases, asymptomatic. Its diagnosis is challenging for diagnostic departments. Symptomatology of the larger gastric diverticula can imitate other illnesses for some time. Initially we can treat it like abdominal pain, gallbladder or kidney colic, back pain, or gastroesophageal, or duodenogastric reflux disease. Common use diagnostic examinations like X-ray of the abdomen or thorax, or ultrasound of the abdominal cavity often cannot find the origin of the problems. It is the least common gastrointestinal diverticulum, therefore its presence can be lost from the minds of the examination specialists. In case of successful diagnosis of the gastric diverticulum the next therapy is led due to clinical state of the patient and according to symptomatology. Almost all gastric diverticula are set for conservative therapy. We can decide for surgery when complications such as bleeding or signs of the perforation occur and according to some problems, which can limit the patient in common life (such as pain, dysphagia, odynophagia or reflux disease).
Case report: Authors present a case of a 64-years-old patient, which was examined for abdominal pain in the epigastrium with night episodes of gastroesophageal reflux and cough for 2 years. Contrast examination of the upper gastrointestinal tract was performed in the past, but did not reveal any pathology. Therefore, a recent gastrofibroscopic examination of the stomach followed. The results were unclear and showed the possibility of the presence of hiatal hernia or stomach diverticulum untill computer tomography scans gave clear diagnosis of stomach diverticulum. It was located in the fundus area in the rear stomach wall and it was in intimate contact with the spleen and left adrenal gland. Because of patient’s symptoms, robotic resection of the diverticulum was indicated after consultation.
Conclusion: Stomach diverticulum is a very rare anatomic abnormality in general. Surgical treatment is indicated in the low range of all stomach diverticula. Literature reviews show mostly single case reports or small groups of patients with stomach diverticula. There is no recommendation for treating management. Surgical approach should be individual and based on symptoms and complications connected to diverticulum presence.
diverticulum – dysphagia – Stomach – Abdominal pain – gastroscopy
1. Shah J, Patel K, Sunkara T et al. Gastric diverticulum: a comprehensive review. Inflamm Intest Dis 2019; 3(4): 161–166. doi: 10.1159/000495463.
2. Gockel I, Thomschke D, Lorenz D. Gastroin testinal: gastric diverticula. J Gastroenterol Hepatol 2004; 19(2): 227. doi: 10.1111/j.1440-1746.2004.3339b.x.
3. Marano L, Reda G, Porfidia R et al. Large symptomatic gastric diverticula: two case reports and a brief review of literature. World J Gastroenterol 2013; 19(36): 6114–6117. doi: 10.3748/wjg.v19.i36.6114.
4. Mahajan S, Naik S, Giri A et al. A case of gastric diverticulum presenting as upper gastrointestinal bleeding in rural central India. Cureus 2022; 14(8): e28403. doi: 10.7759/cureus.28403.
5. Ramai D, Ofosu A, Reddy M. Gastric diverticula: a review and report of two cases. Gastroenterology Res 2018; 11(1): 68–70. doi: 10.14740/gr936w.
6. Al Ghadeer HA, Al Hassan AS, AlAli NH et al. An incidental finding of asymptomatic gastric diverticula. Cureus 2022; 14(11): e31250. doi: 10.7759/cureus.31250.
7. Meeroff M, Gollán JR, Meeroff JC. Gastric diverticulum. Am J Gastroenterol 1967; 47(3): 189–203.
8. Schweiger F, Noonan JS. An unusual case of gastric diverticulosis. Am J Gastroenterol 1991; 86(12): 1817–1819.
9. Anaise D, Brand DL, Smith NL et al. Pitfalls in the diagnosis and treatment of a symptomatic gastric diverticulum. Gastrointest Endosc 1984; 30(1): 28–30. doi: 10.1016/s0016-5107(84)72291-7.
10. Rodeberg DA, Zaheer S, Moir CR et al. Gastric diverticulum: a series of four pe diatric patients. J Pediatr Gastroenterol Nutr 2002; 34(5): 564–567. doi: 10.1097/00005176-200205000-00019.
11. Reich NE. Gastric diverticula. Am J Dig Dis 1941; 8(3): 70–76. doi: 10.1007/bf03014635.
12. Palmer ED. Gastric diverticula. Int Abstr Surg 1951; 92(5): 417–428.
13. Palmer ED. Gastric diverticula, with special reference to subjective manifestations. Gastroenterology 1958; 35(4): 406–408.
14. Seltzer MH, Koch AW. A huge gastric diver ticulum. Am J Dig Dis 1971; 16(2): 167–170. doi: 10.1007/BF02284458.
15. Moses WR. Diverticula of the stomach. Arch Surg 1946; 52 : 59–65. doi: 10.1001/archsurg.1946.01230050061005.
16. Donkervoort SC, Baak LC, Blaauwgeers JL et al. Laparoscopic resection of a symptomatic gastric diverticulum: a minimally invasive solution. JSLS 2006; 10(4): 525–527.
17. Morris PD, Allaway MG, Mwagiru DK et al. Gastric diverticulum: a contemporary review and update in management. ANZ J Surg 2023; 93(12): 2828–2832. doi: 10.1111/ans.18707.
18. Feng YE, Zhang Z. Gastric diverticulum simulating a left adrenal mass: a case report and review of the literature. Oncol Lett 2015; 10(4): 2477–2480. doi: 10.3892/ol.2015.3559.
19. Nakajo M, Umanodan T, Nakajo M. A case of bilateral adrenal pseudotumors caused by hepatic cavernous hemangioma and gastric diverticulum. Jpn J Clin Radiol 2002; 47 : 573–577.
20. Kodera R, Otsuka F, Inagaki K et al. Gastric diverticulum simulating left adrenal incidentaloma in a hypertensive patient. Endocr J 2007; 54(6): 969–974. doi: 10.1507/endocrj.k07e-025.
21. Araki A, Shinohara M, Yamakawa J et al. Gastric diverticulum preoperatively diagnosed as one of two left adrenal adenomas. Int J Urol 2006; 13(1): 64–66. doi: 10.1111/j.1442-2042.2006.01236.x.
22. Schwartz AN, Goiney RC, Graney DO. Gastric diverticulum simulating an adrenal mass: CT appearance and embryogenesis. AJR Am J Roentgenol 1986; 146(3): 553–554. doi: 10.2214/ajr.146.3.553.
23. Muis MO, Leitao K, Havnen J et al. Gastric diverticulum and halitosis – a case for surgery? Int J Surg Case Rep 2014; 5(7): 431–433. doi: 10.1016/j.ijscr.2014.04.029.
24. DuBois B, Powell B, Voeller G. Gastric diver ticulum: “a wayside house of ill fame” with a laparoscopic solution. JSLS 2012; 16(3): 473–477. doi: 10.4293/108680812X13462882736330.
MUDr. Jaroslav Pažin
Chirurgická klinika
2. LF UK a ÚVN – VFN Praha
U vojenské nemocnice 1200
162 00 Praha 6
pazin.jaroslav@uvn.cz
Don‘t have an account? Create new account
Enter the email address that you registered with. We will send you instructions on how to set a new password.
