Gastric Diverticulum

Submitted by Amanda Smolock, MSIV

General Considerations

  • Rare
    • 0.01-0.11% detection rate by endoscopy
  • Types
    • True congenital
      • Contains all layers
      • Usually on the posterior wall of the stomach at the cardia
    • Intramural
      • Projects into muscular layer
      • Usually on the greater curvature of the antrum
    • False
      • Contains mucosa and submucosa without muscularis propria
  • Often near the esophagogastric junction
  • Acquired diverticula may be associated with peptic ulcer disease, bowel obstruction, cancer, and gastric surgery

Clinical Findings:

  • Usually asymptomatic often found incidentally on imaging
  • May rarely be symptomatic and then, usually when diverticulum is in the prepyloric region
  • Symptoms may include epigastric pain, lower chest pain, abdominal pain, dyspepsia, bleeding, nonbilious emesis

Imaging Findings

  • Barium Study
    • Well-circumscribed, barium or air-containing, rounded outpouching with an air-fluid level if the patient is upright
    • Typically 1-3cm in size
  • Endoscopy
    • Diverticulum with a well-defined opening
  • Computed Tomography
    • Outpouching that distorts the normal contour of the stomach

Complications

  • Hemorrhage
  • Ulceration
  • Perforation
  • Torsion

Treatment

  • Deferred for asymptomatic diverticula
  • Surgical intervention for symptomatic diverticula

Prognosis

  • May be associated with an increased risk of malignancy



Gastric Diverticulum. There is an outpouching arising from the cardia of the stomach (white arrow)
containing barium on this double contrast upper gastrointestinal examination, representing
the typical location and appearance of a gastric diverticulum.

For this same photo without the arrows, click here
For more information, click on the link if you see this icon

       

References:
Doherty GM: Current Diagnosis & Treatment, 13th Edition.
Feldman: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th Edition.
Mohan P, Ananthavadivelu M, Venkataraman J.  Gastric diverticulum.  CMAJ 2010; 182(5):E226.
Yamada T: Textbook of Gastroenterology, 5th Edition.