Gastrointestinal: Bleeding gastric diverticulum
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
23
Journal Issue
2
Pages
336
Date Issued
2008
Author(s)
Abstract
Gastric diverticula are outpouchings from the stomach that have similar characteristics to duodenal, jejunal and colonic diverticula. Typical diverticula have a sac, 1–3 cm in diameter, with a thin wall that is largely composed of attenuated strands of smooth muscle. The sac is covered internally by normal gastric mucosa and externally by serosa. Diverticula are rare in children and are thought to develop in adults when high intraluminal pressures develop at sites of weakness in the gastric wall. Almost all diverticula are located on the posterior aspect of the proximal stomach within 3 cm of the gastroesophageal junction. Gastric diverticula are uncommon at upper gastrointestinal endoscopy with a frequency of approximately 1 in 500 procedures (0.2%). They are best seen with retroflexed views of the proximal stomach. Most are asymptomatic but larger diverticula have been associated with epigastric discomfort, prominent burping and esophageal reflux. In relation to complications, there are case reports of ulceration and cancer formation within a diverticulum. Diverticulitis appears to be extremely rare as the mouth of the diverticulum is relatively wide. In the patient illustrated below, the complication was that of bleeding from the margin of the diverticulum. The patient was a 67-year-old man who was admitted to hospital because of melena over the preceding 4 days. He had a previous history of peptic ulcer disease. His hemoglobin on admission was 85 g/L. At upper gastrointestinal endoscopy, it was not possible to see a bleeding lesion with the patient in the left lateral position. However, when he was changed to a right lateral position, an exposed vessel in a small ulcer was found on the margin of a gastric diverticulum (Fig. 1). The lesion was injected with epinephrine (1:10 000) and subsequently treated with hemoclips. Thermal coagulation was avoided because of the potential risk of perforation. Bleeding settled after endoscopic therapy. A subsequent barium study (Fig. 2) showed a diverticulum, 4 cm in diameter, arising from the posterolateral aspect of the proximal stomach (arrows).
SDGs
Publisher
Blackwell Publishing
Type
journal article