Gastric diverticulum: a contemporary review and update in management

Abstract

BackgroundGastric diverticula (GD) are the rarest form of gastrointestinal tract diverticulum, with an estimated incidence of 0.013–2.6%. GD are poorly understood and there are no established management guidelines. Only sparse updates have been published since the mid‐20th century. This paper reviews the current literature and provides some suggested guidelines for the management of GD.MethodsA search of Medline via OvidSP and Google Scholar for ‘gastric diverticulum’ and associated synonyms from the year 1950 onwards was performed. We included randomized controlled trials (RCTs), cohort and case–control studies, and case series. Full text, English language manuscripts on adult populations were included.ResultsA total of 103 manuscripts were included in the final selection – 77 individual case studies, 23 case series and three reviews. No RCTs, cohort or case–control studies were found. The case studies represent 305 patients, 50.8% female with average age 49.2 years (range 18–80). The most common symptom was abdominal pain (48.2%). The average maximum diameter was 3.97 cm (range 0.5–9). One hundred and four patients were managed operatively. Despite persistent recommendations in the literature that GD > 4 cm should be considered for resection, there are no data supporting this approach.ConclusionThe evidence pertaining to the management of GD is sparse. The decision for operative management should be individualized and based primarily on the presence of symptoms or complications which may be directly attributable to the GD. Where surgery is indicated, a laparoscopic approach, potentially with intra‐operative gastroscopy, is appropriate.

Gastric diverticulum mimicking a left renal mass: A case report

“…It is a very rare condition: indeed, Schramm only found 0.12% cases of GD in his series, 1 whereas Morris highlighted an average age of diagnosis at 49.2 years, with both males and females being equally affected by the condition. 2 …”

“…Although most individuals with GD are asymptomatic, others can present with variable abdominal symptoms, including epigastric pain, nausea, vomiting and dyspepsia. 2 …”