In August 2000, a 30-year-old woman presented with fatty food intolerance, gas belch symptoms, abdominal discomfort, and a sour taste in her mouth. She underwent an uncomplicated laparoscopic cholecystectomy; pathology confirmed cholelithiasis and chronic cholecystitis. Her symptoms resolved postoperatively. Four months later, she returned complaining of halitosis, sour taste, bloating, and right-sided abdominal pain of 3-months' duration. She denied having any heartburn. Her family physician had treated her with omeprazole, which initially alleviated the symptoms. Her repeat abdominal examination was normal. An esophogastroduodenoscopy disclosed small fundic polyps and a gastric diverticulum near the fundus that contained old food particles (Figure 1). Minor changes were noted at the gastroesophageal junction that were consistent with mild reflux disease.
Pathology revealed benign fundic polyps; biopsies were negative for evidence of Helicobacter pylori. An upper gastrointestinal series revealed a diverticulum in the posterior cardia of the stomach (Figure 2). Seven months after her initial presentation, the patient underwent a laparoscopic resection of the diverticulum.
A pneumoperitonieum was obtained with an open Hassan technique. A right-sided port was used to elevate the liver and 2 left-sided ports were used to take down the short gastric vessels with the AutoSonix ULTRASHEARS (US Surgical, Tyco Health Care, Norwalk CT). The posterior cardia of the stomach was then mobilized and inspected.
The gastric diverticulum was isolated, dissected free of retroperitoneal attachments to the base of the diverticulum, and transected with an ENDO GIA Universal (US Surgical, Tyco Health Care, Norwalk, CT) (Figure 3). Pathology revealed a 3.0 x 2.5 x 2.0-cm pouch with layers of mucosa, muscularis mucosa, submucosa, and serosa, but not the muscular propria. Postoperatively, the patient did well; at 28-month follow-up, no further symptoms were reported.