Case Report on Gastric Diverticulum

Eugene Richard Joweni Baloyi and colleagues from the University of Witwatersrand, Klerksdorp Tshepong Hospital Complex, South Africa have reported a rare case of gastric diverticulum in a young female with chronic gastritis. The study is published in the International Journal of Surgery Case Reports.

Gastrointestinal upset is a common presentation to surgical departments, often requiring investigation with endoscopy. Pathologies such as gastritis or ulcers are common culprits. However, the occurrence of rare or unusual pathologies, such as gastric diverticula, is seldom noticed and reported.

Gastric Diverticula are the manifestation of a common condition in an unusual location. Their clinical implications vary from being insignificant to life-threatening when complicated by hemorrhage, perforation, or malignant transformation. The associated symptoms are non-specific, and diagnosis may be challenging. Gastric diverticula are rare worldwide with an incidence of 0.02% in autopsy studies. The diagnosis is based on a history of vague abdominal symptoms coupled with non-specific physical signs, which may mimic more prevalent gastrointestinal conditions. For this reason, a high index of suspicion is required should one intend on making the diagnosis.

Therefore, the authors studied a 26-year-old female, with no known co-morbid conditions who presented with a two-week history of abdominal pain associated with nausea and vomiting.

On further inquiry, she had one episode of blood-stained vomiting, prompting investigation with an oesophagogastroduodenoscopy (OGD). Findings included diffuse hemorrhagic gastritis with a single outpouching measuring 1–2 cm in the gastric fundus. A gastric diverticulum was confirmed on barium swallow. Investigation with sonar and a Computed Tomography (CT) scan reported the stomach as normal.

The case highlights the importance of selecting appropriate imaging modalities for luminal structures, which is only diagnosed in 2 (OGD, Swallow) of the four modalities (including ultrasound and CT scan) used. Treatment may be conservative or surgical and is patient dependent, describes Baloyi.

Hence, the authors concluded that "the patient was successfully treated non-operatively with proton pump inhibitor therapy for her concomitant gastritis. Gastric Diverticula are often associated with other gastric findings and their individual contribution varies from case to case."