Gastric diverticulum and halitosis—A case for surgery?

Abstract

INTRODUCTIONGastric diverticulum is a rare and frequently asymptomatic condition. Symptoms include vague pain, fullness, dyspepsia, vomiting, hemorrhage and perforation. Occasionally, the patient can present with belching and oral fetor.PRESENTATION OF CASEWe report a 58-year-old woman with a gastric diverticulum who was suffering from a socially disabling oral fetor. After a thorough evaluation, a laparoscopic resection of the diverticulum was offered and completed successfully. At follow-up, the oral fetor had disappeared. The patient had no complaints and regarded herself as cured.DISCUSSIONAlthough indications for the treatment of asymptomatic patients remain to be defined, pharmacological therapies including protein pump inhibitors and histamine receptor blockers have been employed, with limited effects in patients with miscellaneous symptoms. Surgery is required when serious complications such as hemorrhage or perforation of the diverticulum occur.CONCLUSIONSurgery is required when serious complications such as hemorrhage or perforation of the diverticulum occur. Therapy resistent social disabling oral fetor may add to the indications for surgery.

Gastric Diverticulum: A Comprehensive Review

“…In 2 cases, described earlier in this literature review, this approach was effectively performed without any technical difficulties [8, 25]. In experienced hands, a laparoscopic dissection is frequently easier to perform.…”

“…Vomiting and dyspepsia are less common [6]. Still other patients may report a long history of frequent belching and a socially disabling halitosis, possibly due to retention of food and bacterial overgrowth inside the GD [5, 7, 8, 25]. …”

Indications for Surgical Resection of the Gastric Diverticulum

“…[5][6][7] However, even after removal of his large gastric diverticulum, our patient did not experience an acceptable improvement in symptoms by 5-month followup, making this case a counterpoint to those currently in the literature. Although postoperative imaging was not pursued, intraoperative visualization of adequate resection with the gastroscope makes persistence of a portion of the diverticulum unlikely.…”

“…4 Troublesome belching with oral fetor has also been linked to this condition and presents a more unique question of whether medical or surgical management is most appropriate. 5 Three previous case reports have documented successful resolution of persistent oral fetor after diverticulectomy, [5][6][7] with food retention and bacterial overgrowth within the diverticula having been suggested as explanations for belching and oral fetor. 8 With so few reported cases of surgical management, we present our experience with laparoscopic diverticulectomy performed for persistent halitosis and seek to add our unique input on the proper management of this condition in the nonurgent setting.…”

Divertículos gástricos subcardiales: un hallazgo endoscópico poco frecuente

“…Si los divertículos continúan con síntomas severos a pesar del tratamiento farmacológico o se complica por su gran tamaño (diámetro superior a 4 cm), se indica la resolución quirúr-gica por vía laparoscópica (22). Esta técnica actualmente es bien aceptada, siendo mínimamente invasiva y altamente efectiva (23,24).…”