Surgical therapy of congenital stomach diverticulum

Gastric diverticulum is a very rare condition and, in most cases, asymptomatic. Its diagnosis is challenging for diagnostic departments. Symptomatology of the larger gastric diverticula can imitate other illnesses for some time. Initially we can treat it like abdominal pain, gallbladder or kidney colic, back pain, or gastroesophageal, or duodenogastric reflux disease. Common use diagnostic examinations like X-ray of the abdomen or thorax, or ultrasound of the abdominal cavity often cannot find the origin of the problems. It is the least common gastrointestinal diverticulum, therefore its presence can be lost from the minds of the examination specialists. In case of successful diagnosis of the gastric diverticulum the next therapy is led due to clinical state of the patient and according to symptomatology. Almost all gastric diverticula are set for conservative therapy. We can decide for surgery when complications such as bleed-ing or signs of the perforation occur and according to some problems, which can limit the patient in common life (such as pain, dysphagia, odynophagia or reflux disease).

Authors present a case of a 64-years-old patient, which was examined for abdominal pain in the epigastrium with night episodes of gastroesophageal reflux and cough for 2 years. Contrast examination of the upper gastrointestinal tract was performed in the past, but did not reveal any pathology. Therefore, a recent gastrofi-broscopic examination of the stomach followed. The results were unclear and showed the possibility of the presence of hiatal hernia or stomach diverticulum untill computer tomography scans gave clear diagnosis of stomach diverticulum. It was located in the fundus area in the rear stomach wall and it was in intimate contact with the spleen and left adrenal gland. Because of patient's symptoms, robotic resection of the diverticulum was indicated after consultation.

Stomach diverticulum is a very rare anatomic abnormality in general. Surgical treatment is indicated in the low range of all stomach diverticula. Literature reviews show mostly single case reports or small groups of patients with stomach diverticula. There is no recommendation for treating management. Surgical approach should be individual and based on symptoms and complications connected to diverticulum presence.