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Chapter 22 (page 102)
According to Cockrell et al. (l984) the striking feature of the lesion was its unique
location on the greater curvature of the "distal antrum". No ready explanation could be
found for its occurrence in this particular situation and the etiology remained unknown.
We believe the explanation probably lies in the anatomical build of the pyloric
sphincteric cylinder as described previously (Chap. 3). In all 3 our cases the intramural
diverticulum occurred on the greater curvature between the right and left pyloric loops, a
fact which became clear during contraction of the loops. In this region the musculature
of the cylinder is at its thinnest; it is surmized that the intramural diverticulum consists of
a projection of mucosa and submucosa into the relatively sparse muscle fibres. It is best
visible when the region is distended, becoming compressed or smaller during contraction
of the muscular rings and intervening musculature. According to the descriptions of
Samuel (l955), Flachs et al. (l965), Treugut and Olsson (l980) and Cockrell et al. (l984)
their cases will also fall into this category, and so will some of the cases described by
Rabushka et al. (l968), Treichel et al. (l976) and Dickinson and Freeman (l986).
An intramural gastric diverticulum should not be confused with the pseudo-diverticulum
of the pylorus, which is a fleeting, physiological outpouching of all layers of the wall
occurring normally during contraction of the sphincteric cylinder (Chap.13). An
intramural gastric diverticulum may be seen on the greater curvature aspect of the
physiological pseudodiverticulum during a stage of contraction of the sphincteric
Whether it is a congenital or acquired lesion, is not known.
- Cockrell CH, Cho SR, Messmer JM, et al. Intramural gastric diverticula: a report
of three cases. Brit J Radiol l984, 57, 285-288.
- Dickinson RJ, Freeman AH. Partial gastric diverticula: radiological and
endoscopic features in six patients. Gut l986, 27, 954-957.
- Flachs K, Stelman HH, Matsumoto PJH. Partial gastric diverticula. Amer J
Roentg Rad Ther Nucl Med l965, 94, 339-342.
- Rabushka SE, Melamed M, Melamed JL. Unusual gastric diverticula: report of
two cases. Radiology l968, 90, 1006-1008.
- Samuel E. Gastric diverticula. Brit J Radiol l955, 28, 574-578.
- Treichel J, Gerstenberg E, Palme G, et al. Diagnosis of partial gastric diverticula.
Radiology l976, ll9, 13-18.
- Treugut H, Olsson SA. Intramurales Magendivertikel. Fortschr Geb
Röntgenstr Nuklearmed l980, 133, 327-328.
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