S6398 Rare Case of Gastric Diverticulum: Unique Pathology in a 62-Year-Old Woman

Introduction: Gastric diverticula are the rarest of gastrointestinal diverticula. Prevalence ranges from 0.04% in contrasted radiography studies and 0.01% to 0.11% at esophagogastroduodenoscopy (EGD). Congenital gastric diverticula are true diverticula; they contain all layers of the stomach wall. Acquired gastric diverticula are pseudodiverticula; pulsion-type herniation through the gaps in the muscular layer of the gastric wall. Gastric diverticula are most commonly congenital, located in the fundic region. Acquired gastric diverticula are hardly ever observed, typically located in antrum, and occur concurrently with other gastric pathology. Computed tomography (CT) scan will reveal a well-defined saccular collection of gas or fluid that demonstrates communication with the gastric cavity often seen as filling with iodinated oral contrast. This case highlights clinical manifestations, diagnostic considerations, and management of gastric diverticula. Case Description/Methods: Sixty-two-year-old woman with history of gastroesophageal reflux disease, migraines, and hypertension presented with abdominal pain, chest pressure, regurgitation, frequent eructation with foul odor, and early satiety of 4 months duration. Esophagogastroduodenoscopy (EGD) revealed a medium sized “paraesophageal hernia.” She was referred to general surgery for further management. Computed tomography (CT) abdomen and pelvis completed 2 months prior was reviewed along with recent EGD. CT displayed a 7 cm posterior gastric diverticulum. She underwent robotic partial gastrectomy with resection of the gastric diverticulum in the fundus. Intraoperatively, EGD confirmed successful resection of the diverticulum along with discovery of phytobezoar. Two weeks post op, symptoms of eructation resolved with improvement in abdominal pain. Pathology exhibited saccular unremarkable gastric oxyntic mucosa-lined pouch, consistent with acquired diverticulum, negative for significant diverticulitis, mucosal inflammation, mass lesion, neoplasia, or malignancy. She was placed on diet avoiding high cellulose foods and prescribed Enzymatica ™ daily to aid digestion. Discussion: This case demonstrates an unusual gastric diverticulum in setting of undiagnosed gastroparesis with phytobezoar. Pathology supports an acquired diverticulum. The coexistence of chronic gastroesophageal reflux disease and gastroparesis raises the possibility that altered gastric motility and raised intragastric pressure were pathophysiologic drivers in the development and progression of the diverticulum. This case depicts the need to consider motility disorders as potential etiologic contributors of symptomatic gastric diverticula.