Laparoscopic management of a gastric diverticulum: Case report and literature review

Abstract

Rationale: Gastric diverticulum (GD) is a rare condition characterized by an abnormal bulging pouch in the stomach wall, most commonly located in the fundus. Although GD is typically asymptomatic, it can lead to various nonspecific upper gastrointestinal symptoms, posing a challenge for diagnosis and management.

Patient concerns: A 28-year-old female patient presented with morning emesis, which prompted an investigation and the eventual diagnosis of a symptomatic GD. The patient's condition was unusual due to her young age and the presence of symptoms typically not associated with GD.

Diagnoses: The diagnosis of GD was confirmed after a series of diagnostic tests that included an abdominal ultrasound, abdominal magnetic resonance imaging and barium swallow. The condition is typically rare in younger individuals and can be easily overlooked due to the nonspecific nature of its symptoms.

Interventions: An esophagogastroduodenoscopy was ordered to exclude other pathology and showed a gastric fundal diverticulum with preserved architecture and no signs of inflammation. The patient was successfully treated using a laparoscopic approach, which is becoming the treatment of choice for large or complicated gastric diverticula.

Outcomes: The laparoscopic surgery resulted in the resolution of the patient's symptoms, with no reported complications post-surgery. The patient had a favorable recovery and was discharged with no ongoing gastrointestinal issues.

Lessons: This case emphasizes the importance of considering GD in differential diagnoses for patients presenting with vague upper gastrointestinal symptoms, even in younger individuals. It also highlights the effectiveness of laparoscopic surgery as a minimally invasive and successful treatment option for GD.

Keywords: case report; epigastric pain; gastric diverticulum; laparoscopy; stomach; surgery.

Figure 1.

Abdominal ultrasound showing a 2 cm hepatic adenoma.

Figure 2.

Abdominal MRI: The asterisk designates the gastric diverticulum at the level of the posterior fundus. MRI = magnetic resonance imaging.

Figure 3.

Barium swallow showing the presence of a fundal gastric diverticulum.

Figure 4.

Esophagogastroduodenoscopy presenting the gastric diverticulum at the fundal level posteriorly.

Figure 5.

Gastric mucosa demonstrating healthy stomach lining with no signs of disease, inflammation, or infection and a normal cellular composition and organization.

Figure 6.

The gastric diverticulum specimen compared to the blade number 11. (A) the body of the GD, (B) the base of the GD. GD = gastric diverticulum.

Figure 7.

Low power view (2×) of the full thickness gastric wall showing the attenuated muscularis propria layer associated with the diverticulum.

Figure 8.

Follow-up abdominal ultrasound showing a stable 2 cm hepatic adenoma.