Gastric Diverticulum

Fig. 1: Axial contrast-enhanced T1W MR image shows a mass (arrows) in the gastrohepatic ligament with internal low signal intensity, incidentally seen on the study performed for other reason in a young male.

Fig. 2: A coronal-reformatted CT image shows that the mass is filled with air and oral contrast material with a narrow communication (arrows) with the gastric lesser curvature.

Facts: Gastric Diverticulum

• Incidence: 0.02% in autopsy studies, 0.04% on upper GI studies
• True diverticula have complete wall, believed to be congenital. False diverticula are either traction or pulsion, and associated with inflammation or other diseases
• True diverticula commonly arises from the posterior wall of the cardia, 2 cm below the EG junction or 3 cm from the lesser curvature.
• Most are asymptomatic but they may cause epigastric pain, dysphagia, belching, bloating and early satiety.
• Rare complications: bleeding, diverticulitis, perforation and cancer

Imaging

• Thin-walled, air-containing outpouching from the stomach. May contain fluid or gastric content
• Size 1-5 cm, mostly less than 4 cm
• If it is filled only with fluid, it can be difficult to differentiate from cystic tumor on cross-sectional imaging.

References:

1. McKay R. Laparoscopic resection of a gastric diverticulum: a case report. JSLS 2005; 9:225-228.

2. Coakley F. Pearls and pitfalls in abdominal imaging: pseudotumors, variants and other difficult diagnoses. Cambridge University Press, 2010.