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Abstract: A 48-year-old patient was admitted to the hospital due to severe abdominal pain and vomiting caused by a gastric diverticulum. After surgery and medication, the patient’s condition improved. Gastric diverticulum is generally a restricted pouch or sac-like protrusion of the gastric wall, which is asymptomatic for most patients, and a small number of patients may experience nausea, dyspepsia, pain and other discomforts. Most gastric diverticula are only found when doing a barium meal examination of the stomach or doing gastroscopy.
Basic information】Male, 48 years old
Disease Type】Gastric diverticulum
Hospital】The First Affiliated Hospital of Kunming Medical University
Consultation time】February 2021
Treatment plan】Surgical treatment (laparoscopic resection of diverticulum) + medication (omeprazole enteric capsules)
Treatment period】Hospitalization for 3 days, review after 1 month
Results】The patient had a successful surgery and recovered well
I. Initial consultation
On Saturday afternoon, the patient was transferred to our department through emergency treatment. The patient was sitting on the hospital bed with his hands over his abdomen, his brow was furrowed, his teeth were closed, his face was already red, and he let out some sighs from time to time. He reported a sudden dull pain in the upper abdomen about an hour after eating at noon, with a burning sensation and a paroxysmal increase in pain, followed by a feeling of nausea and vomiting once, after which the symptoms did not improve and the abdomen remained painful, so the family brought the patient to the doctor for treatment as soon as possible. After inquiry, we learned that the patient had a similar symptom last month, but it was not as severe as this one, and it soon subsided. After X-ray examination, the patient was found to have a gastric diverticulum and was admitted to the hospital for treatment.
II. Treatment process
The patient was instructed to adopt a supine right anterior oblique position for an examination X-ray barium angiography, which revealed an obvious diverticulum at the bottom of the patient’s stomach. The CT examination revealed an obvious sac-like structure, and the gas-liquid surface was connected to the gastric fundus. After that, the patient underwent fiberoptic gastroscopy as soon as possible. Gastroscopic observation revealed that the edge of the diverticulum was clear and regular, the entrance was approximately round, the surrounding mucosa was basically normal, there was no obvious infiltration, regular contraction could be observed at the mouth of the diverticulum, the size of the entrance of the diverticulum could change, and the mucosal folds protruded into the sac. Pathological examination was taken to confirm the diagnosis of true diverticulum, so the patient was arranged to have the diverticulum removed through laparoscopic surgery, and after surgery, oral omeprazole enteric capsules were given to inhibit gastric acid secretion and protect the gastric wall.
III. Treatment effect
Since the patient’s treatment was timely and the diverticulum was obvious, the inflammation around the diverticulum had not yet led to serious ulceration or even perforation, so the surgical treatment process was relatively simple, and the patient recovered well after the operation, except for slight pain in the wound area, the abdominal pain symptoms had been significantly relieved, and after the anesthetic effect disappeared, the nausea and vomiting and other uncomfortable symptoms disappeared, and after 3 days of inpatient treatment and conditioning, the patient’s indexes returned to normal. Gastroscopy tissue recovery was good, no obvious complications, and the patient was advised to be discharged from the hospital for convalescence. The patient was advised to be discharged from the hospital for recuperation, and was instructed to review the patient regularly 1 month after discharge.
IV. Notes
We are glad that the patient’s condition has effectively improved after 3 days of hospitalization, but we still need to advise the patient to pay attention to the following matters.
1, 1 month after discharge from the hospital to review on time, if any stomach discomfort occurs during the follow-up period should immediately consult the examination, to avoid delays in the diagnosis and treatment of the disease.
2. Patients should eat liquid food first after discharge, and then slowly transition to semi-liquid food or soft food, and resume normal diet if healing is good and there are no other complications after review, but patients are advised to avoid cold, spicy and other stimulating foods to protect the gastric mucosa and avoid secondary damage.
3. Patients are advised to develop a regular diet, avoid high-fat, high-sugar and high-salt diet, eat more vegetables and fruits, drink more water, quit smoking and alcohol, work and rest regularly, ensure sufficient sleep, and improve body immunity.
V. Personal insight
Gastric diverticulum includes pseudodiverticulum and true diverticulum, pseudodiverticulum is the expansion of the mucosa as well as the submucosa layer, no muscle layer expansion, true diverticulum is the whole layer of the gastric wall expansion, its specific etiology is not clear.
1, the patient in this article is diagnosed as a true diverticulum, the efficacy of drug treatment is not obvious, mainly through surgery to treat, drugs can assist in relieving symptoms.
2.Patients who have pain, distension or burning under the glabella are not necessarily manifestations of gastritis or gastric ulcer, but may also be gastric diverticulum, so they should not be diagnosed blindly, but should be carefully examined by gastroscopy.