Symptomatic gastric diverticulum diagnosed with barium examination of the upper gastrointestinal tract

Clinical History

A 55-year-old woman with a history of dyspepsia and regurgitation of undigested food was referred to our department for a barium double contrast technique examination of the upper gastrointestinal (UGI) tract. Initial oesophagogastroduodenoscopy (EGD) depicted a hiatal hernia and was otherwise unremarkable.

Imaging Findings

A saccular, extraluminal, contrast filling lesion with smooth mucosal lining was identified at the posterior aspect of the fundus in close proximity to the gastroesophageal junction. The diverticulum measured approximately 3cm (maximum diameter) when fully distended.
A small hiatal hernia, a small duodenal diverticulum and gastroesophageal reflux were also noted.

Discussion

Gastric diverticula are considered to be quite rare. Prevalence ranges from 0.02% in autopsy studies to 0.04% in barium examinations and 0.01–0.11% at endoscopy. The majority of them (75%) are located near the gastroesophageal junction, most commonly on the lesser curvature or posterior wall, and usually measure less than 4 cm in size. The pathogenesis of the lesions remains controversial. Most diverticula in the gastrointestinal tract are acquired, as a result of herniation of the mucosa and submucosa through a defect in the muscular wall (false diverticula). However, it is supported that gastric diverticula may be congenital as they most commonly involve all layers of the gastric wall (true diverticula). [1-2]

Most gastric diverticula remain asymptomatic. Occasionally, patients may present with upper abdominal pain, dyspepsia or nausea and vomiting. Rarely, more serious complications may occur such as acute upper GI bleeding or perforation. [2]

Currently, EGD is the modality of choice for UGI tract investigation. However, gastric diverticula are usually best visualized with UGI double contrast study. False negative results have been reported with both methods, especially for narrow neck diverticula. CT imaging is the method which most commonly depicts these lesions today incidentally, but can be challenging since gastric diverticula may mimic retroperitoneal pathology on cross sectional imaging. [3-7]

Appropriate management depends mainly on the symptomatology. There is no well-established therapeutic strategy for asymptomatic diverticula. When the diverticulum is large, symptomatic or complicated by bleeding, perforation or malignancy, surgical resection is the treatment of choice. Laparoscopic resection is a safe and effective alternative to open surgery. [8]

Differential Diagnosis List

Final Diagnosis

Gastric diverticulum.

URL:	https://www.eurorad.org/case/11721
DOI:	10.1594/EURORAD/CASE.11721
ISSN:	1563-4086