Prepyloric gastric diverticulum case report: A rare anatomic abnormality with limited clinical consequences

and Importance: Gastric diverticula (GDs) are typically formed on the posterior wall due to congenital or acquired causes. Although diverticula are not uncommon throughout the gastrointestinal tract, GDs are the least common type, and their presence in the prepyloric area is extremely rare. GDs are frequently asymptomatic but can present with serious complications that require surgical intervention in rare cases.

A 54-year-old woman with a history of morbid obesity, hyperlipidemia, and diabetes mellitus (DM) presents with acute onset left upper quadrant (LUQ) abdominal pain. Based on presenting symptoms, an esophagogastroduodenoscopy (EGD) was performed to evaluate possible causes of abdominal pain. Interestingly, EGD revealed a moderately sized (3 cm) prepyloric diverticulum with a small polyp surrounded by normal gastric tissue. Biopsying of the intra-diverticular polyp revealed no abnormal pathology. Further assessment with Computerized Tomographic (CT) scan identified the diverticulum but with no other related gastric or gastrointestinal changes or pathology.

The diverticulum was excluded as a cause of the pain. Hence, a conservative management approach was followed with no change in status for the following three months of observation. The patient continued to report non-specific symptoms but denied further episodes of abdominal pain or serious symptoms.

GDs present with a wide variety of symptoms making the diagnosis difficult without thoroughly examining the entire anatomic region of potential pathology. Although GDs are rare, they are easily identified via EGD or imaging modalities. However, long-term follow-up information is needed to understand this clinical entity's behavior fully.