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Despite the marked increase of diverticulosis, its risk factors have not been adequately elucidated. We therefore aim to identify significantly associated factors with diverticulosis. We also aim to investigate the present state of diverticulosis in Japan. We reviewed the medical records from 1990 to 2010 that included the data of consecutive 62,503 asymptomatic colonoscopy examinees from the general population in Japan. Most recent 3,327 examinees were analyzed with 16 background factors. Among the 62,503 subjects (47,325 men and 15,178 women; 52.1 ± 9.2 years old), diverticulosis was detected in 11,771 subjects (18.8%; 10,023 men and 1,748 women). The incidences of diverticulosis in 1990-2000 and 2001-2010 were respectively 13.0% (3,771 of 29,071) and 23.9% (8,000 of 33,432): the latter was much higher than the former in all age groups and for both genders. Considering the anatomical locations of colorectal diverticula, left-sided ones have markedly increased with age but not significantly changed with times. Univariate analyses of the 3,327 subjects showed significant association of diverticulosis with four basic factors (age, sex, body mass index, blood pressure), three life style-related factor (smoking, drinking, severe weight increase in adulthood), and two blood test values (triglyceride, HbA1c). The multiple logistic analysis calculating standardized coefficients (β) and odds ratio (OR) demonstrated that age (β = 0.217-0.674, OR = 1.24-1.96), male gender (β = 0.185, OR = 1.20), smoking (β = 0.142-0.200, OR = 1.15-1.22), severe weight increase in adulthood (β = 0.153, OR = 1.17), HbA1c (β = 0.136, OR = 1.15), drinking (β = 0.109, OR = 1.11), and serum triglyceride (β = 0.098, OR = 1.10) showed significantly positive association with diverticulosis whereas body mass index and blood pressure did not. The large-scale data of asymptomatic colonoscopy examinees from the general population from 1990 to 2010 indicated that the prevalence of diverticulosis is still increasing in Japan. Age, male gender, smoking, severe weight increase in adulthood, serum HbA1c, drinking, and serum triglyceride showed significant positive association with diverticulosis.

Studies have shown a high risk of tumor development within a bladder diverticulum (BD). We were interested in the relationship between BD and the development of bladder cancer. Herein, we attempted to investigate whether there exists an association between documented BD and subsequent risk of bladder cancer. We identified 10,662 hospitalized urology patients, including 2,134 documented BD patients (study cohort) and 8,528 non-BD subjects (comparison cohort) from Taiwan's National Health Insurance database. Only urology patients were enrolled in the study to minimize selection bias. The two cohorts were frequency-matched 1:4 by age, sex and index-year. Patients with less than one year of follow-up were excluded to avoid inverting cause and effect. Risks of developing bladder cancer were estimated using the Cox proportional hazard regression model. There was an increased bladder cancer risk in the documented BD patients. The incidence of bladder cancer in documented BD patients was 2.60-fold higher than that in the comparison group, and the overall risk-factor-adjusted hazard ratio was 2.63 (95% CI, 1.74-3.97). Moreover, stratified analysis by sex also showed that documented BD patients were at higher risk of subsequent bladder cancer than the comparison cohort. The effect of BD on the risk of bladder cancer was higher in males than in females and was more profound in patients without comorbidities than in those with comorbidities. In this population-based longitudinal study, urology patients with documented BD might have an elevated risk of subsequent bladder cancer. Based on the limitations of the retrospective study design, further studies are required.

A 1‐year‐old female spayed Golden Retriever presented with a 2‐day history of vomiting and a chronic 4‐month history of intermittent diarrhoea. Blood work revealed hepatocellular hepatopathy with mildly elevated baseline cortisol. Abdominal radiographs revealed mineral opacities in the right caudal abdomen, suspicious for foreign material, but with no evidence of small intestinal obstruction. Owners elected to pursue exploratory laparotomy. A firm, tan, irregular structure was observed in the right caudal abdomen with a small adhesion to an adjacent loop of jejunum. The structure placed caudal tension on a loop of jejunum, causing a hair‐pin turn prior to the beginning of the ileum. The structure was removed en bloc and identified as a focal canine intestinal diverticulum with osseous metaplasia via histopathology. A 1‐year‐old female spayed Golden Retriever presented with a 2‐day history of vomiting and a chronic 4‐month history of intermittent diarrhoea. Owners elected to pursue exploratory laparotomy where a firm, tan, irregular structure was observed in the right caudal abdomen with a small adhesion to an adjacent loop of jejunum. The structure was removed en bloc and identified as a focal canine intestinal diverticulum with osseous metaplasia via histopathology.

Low-grade chronic inflammation has been suggested to play a role in uncomplicated asymptomatic and symptomatic diverticular disease. However, population-based studies are lacking. We investigated whether community participants with diverticulosis, with or without symptoms, would have colonic inflammation on histology and serology. In a nested case-control study of 254 participants from the population-based colonoscopy (PopCol) study, colonic histological inflammatory markers and serological C-reactive protein levels were analyzed in cases with diverticulosis and controls without diverticulosis. Statistical methods included logistic and linear regression models. Background variables including age (P = 0.92), sex (P = 1.00), body mass index (P = 0.71), smoking (P = 0.34), and recent antibiotic exposure (P = 0.68) were similar between cases and controls. Cases reported more abdominal pain (P = 0.04) and diarrhea symptoms (mushy and high-frequency stools) than controls (P = 0.01 and P = 0.03, respectively) but were otherwise similar. The median C-reactive protein levels were similar among cases and controls [1.05 mg/L (0.3, 2.7) vs 0.8 (0.4, 2.2), P = 0.53]. There was a trend of increased numbers of cecal lymphoid aggregates in cases vs controls (P = 0.07), but no other associations between diverticulosis and inflammatory markers on histology were found. Similarly, no serological or mucosal inflammation was associated with symptomatic cases of diarrhea or abdominal pain vs asymptomatic controls. In a general community sample, both asymptomatic and symptomatic diverticulosis are not associated with colonic mucosal inflammation. Other explanations for symptomatic colonic diverticulosis need to be identified.

Pharyngoesophageal diverticula have many subtypes, with Zenker's diverticulum being the most common. First described in 1983, a Killian-Jamieson diverticulum is an outpouching in the anterolateral wall at the pharyngoesophageal junction. This is located inferiorly to the cricopharyngeus muscle, unlike Zenker's diverticula which occur superiorly. Killian-Jamieson diverticula are rare and are commonly misdiagnosed as Zenker's diverticula. Less than 30 reports of Killian-Jamieson diverticula have been described in the literature. A 69-year-old man presented with a 2-year symptomatic history, and was found to have simultaneous Zenker's diverticulum and Killian-Jamieson diverticulum. He was treated successfully with open surgical excision of both pouches. Zenker's diverticulum and Killian-Jamieson diverticulum are diagnosed using radiological studies and endoscopy. Their differentiation is important, as surgical management differs. This paper reviews the literature on Killian-Jamieson diverticula and the management options available.

Periampullary diverticulum (PAD) often increases the difficulty of ERCP operation, and there is no standardized treatment strategy. This study compared the efficacy of “small incision + large balloon dilation (EST + EPBD)” with traditional ERCP. 111 patients with PAD complicated with choledocholithiasis were randomly divided into experimental group ( n  = 55, EST < 5 mm + EPBD) and control group ( n  = 56, conventional EST/EPBD). The primary endpoints were one-time stone clearance and adverse event rate, while secondary endpoints included operative time and common bile duct pressure. One-time stone clearance rate: test group 98.1% vs. control group 87.5% ( P  = 0.029) • Mean operation time: 24 ± 9 min vs. 31 ± 11 min ( P  < 0.001) • CBD pressure 6 days after surgery: 11.5 ± 2.3 vs. 8.5 ± 1.6 cm H₂O ( P  < 0.001) • Incidence of postoperative pancreatitis: 3.6% vs. 10.7% ( P  = 0.206). EST + EPBD can significantly improve stone removal efficiency, shorten operation time, and may improve long-term prognosis by preserving Oddi sphincter function.

Background Meckel’s diverticulum is the most common congenital small-bowel anomaly and is usually asymptomatic. However, torsion of Meckel’s diverticulum is an extremely rare complication that can mimic other acute abdominal conditions such as appendicitis or small-bowel obstruction, posing a clinical challenge to surgeons that may result in misdiagnosis, especially in the absence of advanced imaging. Case presentation A 16-year-old Syrian male patient presented to the emergency department with 24-hour duration of severe right lower quadrant pain, vomiting, nausea, and 2-day history of obstipation. Physical examination showed abdominal distention and tenderness in McBurney’s point, while plain abdominal X-ray showed air-fluid levels consist with small bowel obstruction. Computed tomography was not conducted since the device was out of service. Initial diagnosis of acute appendicitis was made on the basis of the clinical findings, and the patient underwent surgery, revealing a normal appendix, prompting exploratory laparotomy where a giant torsed Meckel’s diverticulum with necrosis was demonstrated 45 cm proximal to the ileocecal valve, measuring 7 × 4 × 3 cm. The torsed diverticulum was excised through enterectomy and an end-to-end anastomosis was performed without complications. Postoperative intravenous antibiotics were given (please refer to Graphical Abstract). Conclusion This case demonstrates that torsion of Meckel’s diverticulum can mimic appendicitis and present with small-bowel obstruction and may only be identified during surgery, particularly when advanced imaging is inaccessible. Clinicians should remain vigilant regarding Meckel’s diverticulum and its differential diagnoses in young patients with right lower‑quadrant pain and perform diagnostic exploration if deemed necessary. Graphical Abstract

BackgroundPulsatile tinnitus (PT) is a distressing auditory symptom, frequently caused by vascular anomalies near the temporal bone. Among the rarer venous causes are jugular bulb diverticula, which can be difficult to diagnose and manage.Case presentationWe report the case of a patient in their 40s with persistent right-sided pulsatile tinnitus significantly impairing daily functioning. Imaging revealed two diverticula in the right jugular bulb and an enlarged nuchal emissary vein. Conservative treatment was ineffective. Digital subtraction angiography confirmed the venous origin of the tinnitus through provocation testing and temporary balloon occlusion. A novel endovascular approach using volumetric coils and venous double-jailing technique was pursued.InterventionStent-assisted coil embolization was performed using a double-jailing technique. Two PX-SLIM™ microcatheters were jailed through a single ACCERO® Rex stent, enabling precise deployment of Penumbra PC400 volumetric coils into both diverticula and the enlarged nuchal emissary vein. The procedure was completed without complications under general anesthesia.OutcomeSymptoms resolved immediately and remained absent at follow-up. Dual antiplatelet therapy was tapered to aspirin monotherapy after 12 weeks.ConclusionThis is the first reported case employing volumetric coils in combination with a venous double-jailing technique for treating jugular bulb diverticula. This approach enabled precise and efficient embolization of multiple venous outpouchings through a single stent construct. The procedure was safe, minimally invasive, and led to complete symptom relief. These findings highlight a promising treatment strategy for selected cases of venous pulsatile tinnitus with complex anatomy.