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A 64-year-old man was transferred to our hospital due to a diagnosis of Stanford type A acute aortic dissection complicated by cardiac tamponade. He was in shock status as well. Careful inspection of contrast- enhanced computed tomography revealed Kommerell's diverticulum with the aberrant right subclavian artery running behind the esophagus. The artery connected to the right axillary artery. The left vertebral artery was separately branched from the aortic arch. Primary entry was not detected on the preoperative computed tomography( CT). Left ventricular function was preserved by transthoracic echocardiography. At emergency surgery, total aortic arch replacement with reconstruction of the right axillary artery, both carotid arteries, and the left subclavian artery along with the left vertebral artery was successfully performed. The aberrant right subclavian artery was ligated at the origin. Kommerell' s diverticulum was completely excluded. Postoperative contrast-enhanced CT showed the patency of all reconstructed arteries. Although he suffered from acute cholecystitis and persistent bilateral pleural effusion, he was discharged in a good condition.

A man in his 70s visited our hospital for abdominal pain. Upon admission, abdominal computed tomography findings suggested a duodenal diverticular perforation. Upper gastrointestinal endoscopy revealed an incarcerated enterolith in the periampullary diverticulum. We achieved conservative management by inserting an endoscopic nasobiliary drainage tube into the duodenal diverticulum to aid drainage. The patient was discharged without serious complications 35 days after admission. We report a case of duodenal diverticular perforation with an incarcerated enterolith managed conservatively using endoscopic therapy.

Most patients with calyceal diverticula stones are asymptomatic, but some patients experience fever and low back pain. Here we report a case of calyceal diverticula stones treated by ureteroscopic management. A 41-year-old woman with backache visited a local doctor. She was diagnosed with a urinary tract infection, and prescribed an antibiotic. Her symptoms began to improve, but the ultrasonography showed she had a left renal cystic lesion, so she visited our hospital. Abdominal contrast-enhanced computed tomography (CT) showing in-flow of a contrast agent into the left renal calyceal diverticula located stones in the upper pole. We performed ureteroscopic management of the calyceal diverticula stones in two stages. First, we expanded the neck of the calyceal diverticula by indwelling the ureteral stent at the calyceal diverticula. Then, using a ureteral dilator, we expanded the neck of the calyceal diverticula further and removed the stones in the calyceal diverticula. Treatment with ureteroscopic management was possible due to the location of the calyceal diverticula stones and the success rate was increased by performing the treatment in two stages.

We report a case of an 80-year-old man complaining of dysphagia followed by aspiration pneumonia. Computed tomography of the chest revealed Kommerell's diverticulum associated with the right-sided aortic arch and the vascular ring which was formed by the aortic arch, the left subclavian artery, the ductus arteriosus, and the pulmonary artery around the esophagus and the trachea. Enlargement of the diverticulum was considered to be the cause of dysphagia. The surgery was performed at 20 ℃ under deep hypothermic circulatory arrest. We performed resection of the Kommerell's diverticulum, reconstruction of the left subclavian artery, and transection of the ductus arteriosus to relieve the compression by the esophagus and the trachea. The postoperative course was uneventful and dysphagia disappeared.

A 67-year-old woman encountered a traffic accident and had chest computed tomography(CT) examination. It revealed a 24 mm Kommerell's diverticulum associated with a right-sided aortic arch and a 15 mm saccular aneurysm of an aberrant left subclavian artery. We performed intra-aneurysmal coil embolization for the left subclavian artery aneurysm after a balloon occlusion test of the left subclavian artery. The postoperative course was uneventful.

A 63-year-old woman with abdominal pain was referred to our hospital. Her pancreatic enzymes were elevated, and an abdominal computed tomography (CT) scan showed an enlarged pancreas, consistent with pancreatitis, and gas collection containing an impacted stone adjacent to Vater's papilla. This finding raised the suspicion of a duodenal diverticulum. A subsequent ERCP showed a juxtapapillary duodenal diverticulum (JPDD) filled with calculi and pus. The pancreatitis improved with 2 weeks of conservative treatment. Subsequently, the patient underwent resection of the uterus and bilateral adnexa to remove a large ovarian cyst that was also identified on the admission CT scan. On the third postoperative day, she developed abdominal pain and vomiting. CT revealed small bowel obstruction caused by an enterolith expelled from JPDD. Enterotomy was performed to remove the stone. To our knowledge, only three similar cases have been previously reported in Japan.

A 55-year-old man who was a heavy drinker with a history of diabetes mellitus was admitted to our hospital with the complaint of dysphagia. Upper gastrointestinal endoscopy revealed multiple intramural pseudodiverticula of the esophagus with candida infection in the cervical and thoracic esophagus. It was difficult to pass the endoscope through the lower thoracic esophagus, indicating stenosis. Thoracic computed tomography and esophagogram revealed widespread, multiple confluent pseudodiverticula in the submucosa. A diagnosis of esophageal intramural pseudodiverticulosis with candida esophagitis was made. The stenosis of the esophagus was improved by endoscopic balloon dilatation and antifungal therapy.

A 49-year-old female was followed up at the gynecology clinic after conization for cervical cancer and underwent routine cervical smear, which revealed a cluster of adenocarcinoma cells. Positron emission tomography-computed tomography (PET-CT) showed increased FDG uptake around the proximal urethra. Urethroscopy showed a tumor arising from the urethral diverticulum, and it was revealed to be clear cell adenocarcinoma by cold-cup biopsy. Then, she was referred to our hospital for the treatment of the urethral cancer arising from the urethral diverticulum. MRI showed the urethral diverticulum at circumference of the urethra and a tumor projecting into its lumen. The patient underwent urethrectomy together with resection of the diverticulum tumor and cutaneous vesicostomy. Pathological examination demonstrated pT2, clear cell adenocarcinoma of the urethra. The patient had no local recurrence or metastasis 5 months after the surgery.

The patient was a 76-year-old man. He was referred to our hospital to treat Kommerell's diverticulum and aneurysmal right-sided aortic arch with aberrant left subclavian artery. We performed extended aortic arch replacement using gull-wing approach. He was discharged uneventfully without any complication. Gull-wing approach method has an advantage of wide surgical field and may be useful for extensive thoracic aortic disease.

An 11-year-old female consulted our department with complaints of urinary incontinence and pyuria. She had had a cloacal repair 7 years ago. The radiograph showed four stones in the pelvis. Magnetic resonance imaging showed two diverticula next to the urethra and several low intensity masses in one diverticulum were regarded as stones. Voiding cystourethrography showed normal urinary bladder contraction, although there were residual urine in the diverticula. Preoperatively, these stones were thought to be formed as a result of the long-standing residual urine. Cystourethroscopy showed that the two diverticula existed within the proximal area of the urethral sphincter and four white stones were found in them. Transurethral cystolithotripsy was performed and a surgical staple was found in the core of each stone. The surgical staples had been used for the cloacal repair and they had migrated into the bladder resulted in stone formation. To the best of our knowledge, this is the first report of bladder stones caused by the migration of surgical staples into the bladder after cloacal repair.

Menkes disease is a rare sex-linked disorder of copper metabolism, characterized with several multiple organ dysfunctions. It is frequently associated with seizure disorders, mental retardation, and urologic abnormalities. It may also have some serious respiratory complications, such as upper airway obstruction related to micrognathia, risks of gastroesophageal reflux and the aspiration with poor pharyngeal muscle control, and hazard to easy cerebral bleeding to noxious stimuli and easy fracture of the bones. We report a 1 year and 10 month-old boy of Menkes disease with a large bladder diverticulum associated with persistent urinary tract infections who required the surgical treatment. Cystostomy was scheduled and performed under general anesthesia. In the preoperative examination, three-dimentional computed tomography images were essential and very useful for preanesthetic anatomical evaluation of the upper airway, which revealed subglottic narrowing with micrognathia. Considering the anticipated difficulty of the tracheal intubation, and to avoid or minimize the noxious stimuli related to the intubation, we had chosen to use laryngeal mask airway, which provided an appropriate, safe anesthetic respiratory care in this case.

We report a 49-year-old female who had circumferential urethral diverticulum. She was admitted to our department for urinary retention. A cystic lesion surrounding the urethra had been detected by magnetic resonance imaging. We diagnosed the lesion as a urethral diverticulum after injecting dye to the cystic mass from vagina and confirming its discharge from the urethra at the pubic side by urethroscopy. Transvaginal resection of the diverticulum was peformed. In general, 4% of female urethral diverticula cause urinary retention. On the other hand, 1% of female bladder outlet obstruction is caused by urethral diverticula. It is neccessary for us to keep in mind urethral diverticulum when we evaluate female patients with urinary retention.

A 39-year-old man was admitted to our hospital because of micturition pain and swelling of the penoscrotal junction. On physical examination,a hard mass was palpated in the penoscrotal junction. Retrograde urethrography demonstrated a calculus in the diverticulum of the anterior urethra. After the suprapubic cystostomy, resection and debridment of the diverticulum were performed and the stone was removed by two-staged urethroplasty. After the operation, retrograde urethrography revealed the tissue-like urethral valve, and there was bleeding from the anastomosis of the urethra, but the patient was finally free of the disease.

A 57-year-old man suspected of having angina pectoris underwent coronary angiography and comprehensive examination, which revealed a right-side aortic arch accompanying Kommerell diverticulum and a aberrant left subclavian artery. Esophagography indicated that the esophagus was compressed on its right posterior side and the computed tomography (CT) revealed that the posterior side of the tracheal was compressed, however, the patient experienced no difficulty in breathing, hoarseness of voice or dysphasia. The size of the aortic diverticulum was less than 5 cm and the patient showed no symptom, however, if it was left untreated, there was a risk of rupture in the future. Also the esophagus and tracheal may develop complications due to prolonged compression. Therefore, we decided that the case required surgical operation. Total arch replacement was performed through mediastinotomy and right posterolateral in the 4th intercostal. The postoperative condition was good, and the patient was discharged without any complications.

An 81-year-old woman was admitted with a chief complaint of bloody discharge from the urethra. On physical examination an elastic-soft mass was palpable beneath the anterior vaginal wall. Magnetic resonance imaging and computed tomographic scan revealed the mass around the urethra. Transvaginal needle biopsy was performed and the histopathologic finding was adenocarcinoma. The tumor was excised with the uterus, the ovary and the anterior vaginal wall. The macroscopic appearance suggested that the tumor arose in the urethral diverticulum. She had intravesical recurrence at 8 months after the operation, and partial cystectomy was performed. However there was recurrence again, and radical cystectomy was performed finally. We review 81 cases of urethral diverticular carcinoma in the literature.

We report two cases of a nephrogenic adenoma in the bladder diverticulum. The first patient was an 81-year-old man with gross hematuria. Cystoscopy revealed bladder diverticulum and a papillary tumor within. Bladder diverticulectomy was performed and the histopathological diagnosis was a nephrogenic adenoma. The second patient was a 50-year-old man with gross hematuria and dysuria. Transabdominal ultrasound revealed bladder diverticulum. Transurethral coagulation of the bladder diverticulum was performed. Then three papillary tumors were detected, and were resected transurethrally. The histopathological diagnosis was a nephrogenic adenoma. These are the first and second cases of a nephrogenic adenoma in the bladder diverticulum reported in Japan.

A 49-year-old man was admitted to our hospital with the chief compliant of difficulty of urination, lower abdominal pain and macrohematuria. On cystoscopy, a non-papillary tumor was seen in the diverticulum on the right side of the urinary bladder. Having made the diagnosis of urinary bladder cancer, we performed total cystectomy, retroperitoneal node dissection and construction of an ileal neobladder. Histologically, it was squamous cell carcinoma, pT3a, pN0. Seven months after the operation, the patient died of recurrent disease.

Three cases of transitional cell carcinoma (TCC) in the urinary bladder diverticulum were encountered during a period of 12 years and bladder preserving treatments were performed. Case 1: A 78-year-old man was admitted with a chief complaint of hematuria. Papillary tumors in the diverticulum of the right bladder wall were revealed (TCC, G3, T3N0M0). Intraarterial infusion chemotherapy was performed and complete remission was achieved. When a recurrent bladder tumor appeared 22 months later, transurethral resection was performed and there was no evidence of recurrence for 50 months. Case 2: A 60-year-old man was admitted with a chief complaint of gross hematuria. Cystoscopic examination revealed papillary tumors in a bladder diverticulum near the ureteral left orifice. Transurethral resection revealed TCC G2 and carcinoma in situ. Partial cystectomy, including the bladder diverticulum, and vesicoureteral neostomy was performed. The histological stage of the tumor was pTis and the wall of diverticulum possessed a thin muscle layer histopathologically. Twenty two months later, recurrence in the left bladder wall developed and transurethral resection and bladder instillation therapy were performed. For 21 months he had no evidence of recurrence. Case 3: A 59-year-old man was admitted with a chief complaint of hematuria. A solid tumor in the diverticulum of the bladder left wall was revealed. After 4 courses of intraarterial infusion chemotherapy, 41% remission was achieved and partial cystectomy was performed. Histopathological diagnosis was TCC G3, pT3b, INF-alpha, v (-), ly (-), and no muscle layer was found in the diverticulum. There was no evidence of recurrence 16 months after operation. By using the combination therapy, bladder preserving treatment is possible in the cases of bladder cancer arising in the diverticulum.

A 66-year-old man presented with right flank pain and macroscopic hematuria. Abdominal radiographs and computed tomography revealed a right pyelocalyceal diverticulum with milk of calcium and a soft tissue mass inside it. Other examinations, including positive urine cytology and negative random bladder biopsies, suggested a malignant tumor of the pyelocalyceal diverticulum. The patient underwent right nephroureterectomy. Histopathological examination revealed grade 3 transitional cell carcinoma. This is the first case of transitional cell carcinoma and milk of calcium coexisting in the same pyelocalyceal diverticulum.

A forty four-year-old house-wife presented with gross hematuria and difficulty on urination of a year and 3 months duration. Transvaginal examination showed a hen egg-sized soft mass on the anterior vaginal wall. Urine cytology revealed many clusters of malignant cells suggestive of adenocarcinoma. Cystourethrography revealed two urethral diverticula, whose orifices were cystoscopically located at the proximal and distal side of urethral sphincter, respectively. By vaginal digital pressing, a soy-bean sized papillary tumor came out of the proximal diverticulum. Histopathological examination of the biopsied tumor suggested poorly differentiated transitional cell carcinoma with inverted growth. Under the diagnosis of carcinoma arising in the urethral diverticulum, anterior pelvic exenteration with formation of Indiana pouch was carried out. The tumor in the proximal diverticulum was histologically composed of a variety of adenocarcinomatous pattern, such as tubular, papillary and cystic structure with a distinctive pattern of tubules lined by a superficial layer of hobnail cells, leading to the diagnosis of mesonephric adenocarcinoma of urethral diverticulum. Postoperative radiation therapy was given because the diverticulum was adherent to the pubic bone, though lymph node metastasis was negative. She has been well with no evidence of the disease for 1 year and 4 months after the operation. Although the histogenesis of female urethral mesonephric adenocarcinoma was still controversial, this case seems to be the forty fourth case in the world literature.

A 93-year-old woman admitted because of epigastralgia. Cholelithiasis, obstructive jaundice, acute suppurative cholangitis and acute pancreatitis were diagnosed on blood chemistry and ultrasonography on admission. We performed emergency PTCD. A calculus 4 cm in diameter was detected at the papilla of Vater and marked dilatation of the common bile duct and pancreatic duct. ESWL was performed because of her age and because endoscopical operation seemed to be difficult. After lithotripsy, PTC and endoscopy demonstrated a diverticulum at the peripapillary portion of the duodenum. Based on analysis of PTC result before and after ESWL, we diagnosed this case as Lemmel's syndrome (obstructive jaundice, acute suppurative cholangitis and acute pancreatitis) caused by a large diverticular enterolith at the peripapillary portion of the duodenum. ESWL treatment of aged patient with an enterolith is safe.

A 77-year-old man was admitted to our hospital complaining of gross hematuria. Cystoscopy showed an approximately 4-cm non-papillary tumor in and out of the diverticulum of the left posterior wall. Total cystectomy was performed. Histopathological diagnosis was pleomorphic leiomyosarcoma. According to TNM classification of bladder cancer, the stage of this tumor was pT3bpN0M0. The patient had local recurrence two months after the operation, and died a month later. This is the second case of leiomyosarcoma of the diverticulum of urinary bladder reported in Japan.

We report a successful repair of tetralogy of Fallot and left ventricular diverticulum associated with pentaology of Cantrell. The repair consisted of partial infundibular septectomy, closure of ventricular septum, reconstruction of right ventricular outlet using monocuspid transjunctional patch, and resection of left ventricular diverticulum. The infundibulum was extremely elongated, caused by ventricular dextroversion, and the hypoplasia of pulmonary trunk was absent. Therefore, transjunctional patch was longer, even after infundibular septectomy. This report discuss the pathogenesis of these cardiac anomalies and surgical imlication.

We experienced a case of bladder diverticular tumor with intradiverticular hemorrhage in which preoperative diagnosis was difficult. It simultaneously occurred with a bladder tumor. The patient, a 70-year-old man complained of macrohematuria and pollakisuria. The cystoscopic examination revealed a bladder tumor. The radiographic examination suggested a bladder tumor with extravesical hemorrhage. We diagnosed an invasive bladder tumor and performed radical cystectomy and ileal conduit diversion. Postoperative diagnosis was bladder tumor and diverticular tumor.

A 57-year-old woman was admitted with a chief complaint of difficult urination on June 7, 1993. A filling defect and a large diverticulum were revealed on the cystogram. Cystoscopy showed a tumor, obstructing the internal urethral orifice at the bladder neck and a diverticulum at the right posterior wall of the bladder. Under the preoperative diagnosis of a benign bladder tumor with a diverticulum, resection of the tumor and transvesical diverticulectomy were performed by a suprapubic approach. The resected tumor was smooth-surfaced, elastic soft and was measured 2.0 by 1.5 by 1.0 cm in size. Histologically, the tumor was diagnosed as a benign fibroma of the urinary bladder. The postoperative course was uneventful. Non-epithelial benign bladder tumors are rare. To our knowledge, this is the 18th case of bladder fibroma in the Japanese literature. The characteristics of bladder fibroma are briefly described.

A 77-year-old woman with a previous history of pelvic fracture had suffered from recurrent cystitis. In the excretory urography, post-void upright film revealed the bladder hernia associated with the bladder diverticulum. Transurethral incision and fulguration of the bladder diverticulum and left inguinal herniography was performed. There has been no recurrence since then.

A 60-year-old woman was admitted to our clinic with the chief complaint of high fever. Antibiotic therapy had produced no improvement in another hospital and she was referred to our hospital for further examination and treatment. Intravenous pyelography showed left non visualized kidney and a stone shadow in left ureter. Computed tomography showed a cystic lesion, 9 x 9 x 8 cm, in the upper pole of the left kidney. We punctured and drained 400 cc of turbid yellowish fluid by a transcutaneous route. The nephrostogram clearly showed a communication with infundibulum. A diagnosis of infected caliceal diverticulum was made. Further examination demonstrated no function of left kidney and we performed nephrectomy. She has reported no symptoms for 6 months after the operation.

A case of diverticular stones in the male anterior urethra with retrocaval ureter is reported. A 26-year-old man visited our hospital for examination, who had experienced spontaneous stone discharge a few days earlier. Computed tomographic (CT) scan with ureteral catheterization and urethrography revealed a retrocaval ureter and urethral diverticular stones. Resection of urethral diverticulum with 7 stones and right ureteroplasty were performed. The urethrography and drip infusion pyelography (DIP) 9 months after operation showed no abnormal findings. The largest stone was 28 x 22 x 20 mm in size and 20 g in weight. The main components were ammonium dihydrogen-urate (70%), carbonate apatite and struvite. Histological feature of the epithelium of the urethral diverticulum indicated normal skin with hairs. Pathological diagnosis was para-urethral dermoid cyst. Our case is the 67th case of the male urethral diverticular stones and the first case of those with retrocaval ureter in Japan.

Menkes' kinky hair disease is a poor prognostic congenital disease with X-linked recessive inheritance. This disease is clinically characterized by seizures, friable hair, growth failure, mental retardation and others. Recently it has been known that this disease is also characterized by multiple diverticula of the bladder and other urological abnormalities. A 6-year-old boy was diagnosed as having Menkes' kinky hair disease at another hospital several weeks after birth because of seizures, friable hair and low serum copper level. He voided by Credé's maneuver by the nurse because he could not void for himself. He was referred to our hospital for macrohematuria and micturition pain on October 8, 1989. Right renal staghorn calculus and multiple diverticula of the bladder were found by roentgenographic examination. He has been treated conservatively after discharge because of his poor condition.

Congenital corrected transposition of the great arteries (C-TGA) is frequently associated with VSD and PS. Systemic atrioventricular valve regurgitation is also sometimes present in patients with C-TGA. It is though that left-sided A-V valve regurgitation is caused by the deformities of the tricuspid valve (TV) or intolerance of TV and the right ventricle (RV) against systemic pressure load. We had a patient with C-TGA associated with Ebstein's malformation. The patient suffered from congestive heart failure due to left-sided A-V valve regurgitation. In this case, the septal and posterior leaflets were displaced below the atrioventricular annulus. The edges of all valves were thickened and partially calcified. Focal agenesis was found in the septal leaflet. There was a distinct atrialized ventricle which had a thin wall and no trabeculae. It shaped like a diverticulum of 3 cm in depth toward the diaphragm. Preoperative cardiac catheterization showed that the functional RV had an adequate size (RVEDVI 162% of normal) and ejection fraction was 53%. Left-sided valve replacement was performed using SJM 31M with preservation of TV. Left-sided atrioventricular annulus was so deformed due to the diverticulum that the prosthetic valve was sutured at the ventricular wall below the atrioventricular annulus to which TV had attached. Good clinical result was obtained after surgical treatment.

We reported multiple jejunal diverticula with strongyloidiasis and malabsorption syndrome. To our knowledge, 140 cases including the present one have been reported in Japan. We reviewed these cases in this report.

We report a case of stone-containing pyelocaliceal diverticulum. A 68-year-old man was admitted for extensive investigation of microscopic hematuria on January 12, 1983. A cluster of numerous small calcifications was disclosed in the left renal region on an abdominal plain film and the case was considered to be of stones in the left kidney. An excretory pyelogram showed that the stones were away from the collecting system of the left kidney. Through partial nephrectomy, 107 stones were removed on January 21, 1983. Histological examination of the surgical specimen revealed pyelocaliceal diverticulum. The stones were found to consist of calcium oxalate and calcium phosphate by infrared spectrophotometry. In addition to these components, a small amount of magnesium was detected by X-ray microanalysis. A scanning electron microscopic study of the cut surface of the stones disclosed the presence of a granular core identified as urate and calcium oxalate, concentric laminations of crystallized substances in the mid-zone and laminations of amorphous substances in the outer layer.

A 53-year-old nulliparous woman complained of terminal pain on urination and bended micturition. Previously, she had been treated unsuccessfully with antibiotics for chronic cystitis. On examination, a mass of approximately a thumb's head-size, was palpated at the left portion of urethral meatus. Plain film of the pelvis revealed stones under the margin of symphysis pubis. Positive pressure urethrography revealed a diverticulum slightly larger than the stones. Transvestibular diverticulectomy and urethrolithotomy were performed without any postoperative complications. In Japan, 38 cases of diverticulum calculi of the female urethra have been reported.

Carcinoma of the bladder diverticulum is a relatively rare disease. However, its preoperative diagnosis is often difficult. Also, infiltration occurs easily because the diverticulum wall is thin, and prognosis is said to be relatively poor. Histologically, the occurrence rate of squamous cell carcinoma is markedly high. We have experienced a case of squamous cell carcinoma in the bladder diverticulum occurring simultaneously with transitional cell carcinoma of the bladder; and, report this case along with a review of the literature. The patient, a 79-year-old male, had sudden macroscopic hematuria on December 15, 1980, and went to the urology department of a separate hospital. IVU showed distortion of the right ureter, and the patient was referred to our hospital. Cystoscopy revealed a diverticulum in the right wall of the bladder. In the posterior wall of the bladder 2 papillary sessile tumors were also detected. Pathological diagnosis by cold punch biopsy done after the patient was admitted to hospital revealed a grade III transitional cell carcinoma. Total cystectomy + bilateral cutaneous ureterostomy was performed. The diverticulum was in the right wall of the bladder and a papillary sessile tumor with a diameter of 4 cm was found in the diverticulum. A papillary sessile tumor 2 cm in diameter was found in the left bladder wall. Histopathological diagnosis of the tumor in the diverticulum was squamous cell carcinoma ( pG2 , pT3b , ly1, v(-) INF beta) and that of the tumor in the bladder was transitional cell carcinoma ( ( pG3 , pT2 , ly1, v(-), INF gamma).(ABSTRACT TRUNCATED AT 250 WORDS)

A case of giant vesical diverticulum is reported. A 31-year-old man was admitted with intermittent self-catheterization for 6 months duration due to urinary retention. A cystogram demonstrated a giant solitary diverticulum extended left-posteriorly, which compressed the bladder outlet and caused obstruction. On cystoscopy, the neck of the diverticulum was seen postero-lateral to left ureteral orifice. There was no vesical trabeculation, but slight obstruction of the bladder neck was suspected secondary to intermittent self-catheterization. A diverticulectomy was carried out by combined approach without ureterocystoneostomy. The patient had no difficulty in voiding after the operation.

An aenurysm of a diverticulum of the ductus arteriosus in a 33-year-old man was presented. The chest radiography revealed a mass obscurring the aortic window above the hilus of the left lung. His blood pressure was 130/70 mmHg, and there was no difference in pressures between the upper and lower or between the right and left extremities. A CT scan of the chest showed 30 X 34 mm angioma adjacent to the descending aorta and pulmonary artery. Aortography and contrast radiography of the right ventricle revealed a cystic pedunculated aneurysm at the superior portion of the descending aorta. The base of the left pulmonary artery was slightly displaced. There was no communication between the aorta and pulmonary artery, nor was any significant difference in pressure between the ascending and descending aorta. This case was diagnosed as an aneurysm of the diverticulum of the ductus arteriosus, and then it was resected. The abnormality was confirmed by the localization of the aneurysm and histopathologic findings, but the presence of the ligamentum arteriosum was not confirmed. This is the 23rd case of the aneurysm of the diverticulum of the ductus arteriosus in adults, and the first case in Japan in which the diagnosis was made in a living patient, followed by successful surgery.

One hundred and thirteen cases of juxtapapillary duodenal diverticula were found in 5573 cases which were examined by upper gastrointestinal barium meal X-ray examination. Seventy-nine percent of those 113 cases had complications, while 21% of the cases were suffered from juxtapapillary duodenal diverticula alone. Among the complications, cholelithiasis showed the highest incidence. (33 cases out of 113 cases, 29.2%). Twenty-four cases of juxtapapillary duodenal diverticula of which serum amylase and serum bilirubin values were found to be over the normal range, were subjected to the ERCP and hepatocholedocal RI scintigraphy using 99mTcPI. Fourteen cases out of the 24 cases had complication of cholelithiasis. In 4 cases (28.6%) in this group, delaying of bile-flow was observed. While in 3 cases (30%) out of 10 cases without cholelithiasis, bile-flow disturbance was found. According to above mentioned observations, the following steps were recommended for the treatment of juxtapapillary duodenal diverticula: When juxtapapillary duodenal diverticula is revealed, examinations should be carefully done in order to find out other complications. Treatment for juxtapapillary duodenal diverticula may be done simultaneously with operation of the complications. Surgical indication of the juxtapapillary duodenal diverticula alone should be decided by the result of bile-flow examination.

A case of urethral diverticulum with calculus in a 53-year-old woman is reported. She was admitted to Isahaya General Hospital complaining of a localized swelling in the external genitalia. We found a urethral diverticular calculi by urethrography. Urethral diverticulectomy was carried out without any complications. The removed stones were in 2 pieces and they were composed of calcium phosphate and ammonium urate.

Cases of giant vesical diverticula that cause defecation disturbance are very rare. A 67-year-old man with such a condition was admitted to our hospital complaining of pollakiuria , nycturia , retardation, two-phase urination and defecation disturbance which began about 7 years earlier. A goose-egg-sized tumor touched above the hen-egg-sized prostate and the tumor disappeared after urination. X-ray examinations revealed that defecation disturbance was caused when the sigmoid colon was oppressed by the giant diverticulum. After diverticulectomy and prostatectomy the vesical symptoms and defecation disturbance completely subsided.

A 63-year-old man visited our hospital because of painless macrohematuria. Drip infusion pyelography and retrograde pyelography revealed a space-occupying lesion with extravasation of contrast medium to upper caliceal system. A computed tomographic study revealed an intrarenal solid moiety and further more, arteriography showed the arterial encasement and fine neovascularity of the lesion. On gross section of the extirpated kidney, a cystic cavity measuring 3 by 3 cm existed at the upper pole and apparently channeled to the upper caliceal system. Small stones were found in the cystic cavity. Histopathologically, the wall of the cavity was covered with layered squamous cells and a part of the wall developed metaplasic transitional cell carcinoma proliferation which invaded into the renal parenchyma and renal pelvis, as well.