About the Authors

Associate Professor

Dept. of Medicine

Associate Professor

Dept. of Pathology

Shri Ram Murti Smarak Institute of Medical Science, Bhojipura Bareilly, Uttar Pradesh

Address for correspondence

Dr Praveen Kumar

Associate Professor

Dept. of Medicine

Shri Ram Murti Smarak Institute of Medical Science, Bhojipura Bareilly, Uttar Pradesh - 243 202

Keywords

Upper gastrointestinal endoscopy, reflux esophagitis, antral gastritis, fundal diverticulum

Case Report

A 46-year-old female patient who came for upper gastrointestinal endoscopy with history of upper abdominal pain; which was mild, continuous and increased after meals. Patient was also having intermittent vomiting. Her upper gastrointestinal endoscopy revealed reflux esophagitis with mild antral gastritis and gastric diverticulum (solitary fundal diverticulum) (Fig. 1 a-c).

Discussion

Gastric diverticula are uncommon form of diverticular disease. The incidence ranges from 0.02% in autopsy studies to 0.01% to 0.11% at endoscopy. Gastric diverticula are often single, varying in size from 1 to 3 cm and most commonly found in middle-aged patients with equal sex incidence.1 Akerlund classified gastric diverticula as congenital and acquired. The congenital gastric diverticulum is a ‘true diverticulum’ and involves all layers of the gastric  wall, whereas the acquired variety lacks the muscular or serosal layer referred as ‘false diverticulum’.

True diverticula make up 75% of all gastric diverticula, most commonly located near the gastroesophageal junction (juxtacardiac) on the lesser curvature of the stomach on the posterior aspect. Intramural or partial gastric diverticula are formed by the projection of the mucosa of the stomach through the muscular layer and are found more commonly in prepyloric region usually on lesser curvature.2

Patients with gastric diverticula are often asymptomatic, although juxtacardiac diverticula may present with dyspepsia, vomiting and abdominal pain. Intramural diverticula do not usually cause any symptoms.3,4

Diverticulum is diagnosed incidentally by gastrointestinal endoscopy, radiological investigation (lateral view of barium study and CT scan) and on autopsy. Rarely, it may be associated with complications such as ulceration, perforation, hemorrhage, torsion and malignancy.

There is no specific treatment required for an asymptomatic diverticulum. Surgical resection (open or laparoscopic diverticulectomy) is recommended in large symptomatic and/or complicated juxtacardiac diverticulum. Intramural diverticula require no intervention.5

Acknowledgment

I take this opportunity to extend my gratitude and sincere thanks to all those who helped me to complete this study.

I owe great sense of indebtedness to Dean Shri Ram Murti Smarak Institute of Medical Sciences (SRMS-IMS), Bhojipura, Bareilly for permitting me to carry out this study.

References

1. Jeyarajah R, Harford W. Diverticula of the Hypopharynx, Esopahgus, Stomach, Jejunum and Ileum. In: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th edition, WB Saunders: Philadelphia 2002:p.363-4.
2. Akerlund D. Gastric diverticulum. Acta Radiol 1923;2:476-85.
3. Palmer ED. Gastric diverticulosis. Am Fam Physician 1973;7(3):114-7.
4. Anaise D, Brand DL, Smith NL, Soroff HS. Pitfalls in the diagnosis and treatment of a symptomatic gastric diverticulum. Gastrointest Endosc 1984;30(1):28-30.
5. Fork FT, Tóth E, Lindström C. Early gastric cancer in a fundic diverticulum. Endoscopy 1998;30(1):S2.