Large symptomatic gastric diverticula: Two case reports and a brief review of literature

Abstract

Gastric diverticula are rare and uncommon conditions. Most gastric diverticula are asymptomatic. When symptoms arise, they are most commonly upper abdominal pain, nausea and emesis, while dyspepsia and vomiting are less common. Occasionally, patients with gastric diverticula can have dramatic presentations related to massive bleeding or perforation. The diagnosis may be difficult, as symptoms can be caused by more common gastrointestinal pathologies and only aggravated by diverticula. The appropriate management of diverticula depends mainly on the symptom pattern and as well as diverticulum size. There is no specific therapeutic strategy for an asymptomatic diverticulum. Although some authors support conservative therapy with antacids, this provides only temporary symptom relief since it is not able to resolve the underlying pathology. Surgical resection is the mainstay of treatment when the diverticulum is large, symptomatic or complicated by bleeding, perforation or malignancy, with over two-thirds of patients remaining symptom-free after surgery, while laparoscopic resection, combined with intraoperative endoscopy, is a safe and feasible approach with excellent outcomes. Here, we present two cases of uncommon large symptomatic gastric diverticula with a discussion of the cornerstones in management and report a minimally invasive solution, with a brief review of the literature.

Keywords: Gastric diverticulum, Laparoscopic gastric diverticulectomy, Abdominal pain, Dysphagia, Gastric, Diverticulum

Core tip: Gastric diverticula are infrequent anatomic abnormalities and are usually asymptomatic. They present with variable symptoms. Although most symptomatic patients are diagnosed during evaluation of vague epigastric discomfort, severe complications, including perforation and hemorrhage, may occur. We report a successful laparoscopic approach as a minimally invasive solution to a symptomatic gastric diverticula with a brief literature review on this rare condition. Knowledge of the pitfalls in diagnosis and treatment of a gastric diverticulum are essential for successful and complete relief of symptoms.