Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4895-4901
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4895
Adult metaplastic hutch diverticulum with robotic-assisted diverticulectomy and reconstruction: A case report
Che H Yang, Yi S Lin, Yen C Ou, Wei C Weng, Li H Huang, Chin H Lu, Chao Y Hsu, Min C Tung
Che H Yang, Yi S Lin, Yen C Ou, Wei C Weng, Li H Huang, Chin H Lu, Chao Y Hsu, Min C Tung, Department of Surgery, Division of Urology, Tungs’ Taichung MetroHarbor Hospital, Taichung City 435403, Taiwan
Author contributions: Yang CH was the primary care of this case and responsible for the original draft; Lin YS and Ou YC were the patient's urologist, reviewing the literature and providing comments to the original draft; Ou YC was the main operator to this surgery, and Weng WC and Huang LH were the assistants to the him; Lu CH was responsible for follow-ups after discharge; Hsu CY and Tung MC were responsible for the important intellectual contents and supervisor; Informed consent was proceeded by Ou YC.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yi S Lin, MD, Attending Doctor, Surgeon, Surgical Oncologist, Department of Surgery, Division of Urology, Tungs’ Taichung MetroHarbor Hospital, No. 699 Sec. 8, Taiwan Blvd, Wuqi District, Taichung City 435403, Taiwan. tung12197@gmail.com
Received: May 8, 2020
Peer-review started: May 8, 2020
First decision: July 25, 2020
Revised: August 16, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: October 26, 2020
Processing time: 171 Days and 7.1 Hours
Abstract
BACKGROUND

Hutch diverticulum arises from the compromised muscular development at the ureteral orifice. It is a congenital disease and extremely rare in adult, only accounting for about 3% occurrence worldwide. It can be either symptomatic or asymptomatic, and relies on image tools for diagnosis and preoperative planning. Indications for surgery are dependent on the complications from the diverticulum. Metaplasia is about 10% among those with hutch diverticulum, and it still has chances turning into malignancy, especially urothelial cell carcinoma.

CASE SUMMARY

A 27-year-old man was presented with frequently recurrent urinary tract infection for one year, and had suffered from intermittent right flank pain for 3 mo. No past medical histories were recorded before. No obvious abnormalities on laboratory data and urine examination were found. Under ultrasound, right hydronephrosis was seen and an anatomical abnormality was observed on intravenous pyelography. Further computed tomography urogram showed one diverticulum seated at superolateral side of right ureteral orifice. Cystoscopy was done and biopsy results showed focal metaplasia. After discussing with him, robotic-assisted diverticulectomy with reconstruction was performed. Right hydronephrosis was greatly improved after surgery. He has completed his 1.5-year follow-ups, and no malignancies were seen from urine cytology and image of intravenous pyelography.

CONCLUSION

Robotic-assisted diverticulectomy and reconstruction to hutch diverticulum is a safe and efficient operation, providing several advantages over open and laparoscopic ones.

Keywords: Diverticulum complications; Urinary bladder abnormalities; Diverticulum surgery; Robotic surgical procedures methods; Treatment outcome; Case report

Core Tip: Hutch diverticulum is an uncommon congenital anatomical defects in childhood, involving bladder and ureteral opening. Mostly cases are diagnosed in their first decades and predominately at solitary side. The symptoms prompting one to seek help at clinics include recurrent urinary tract infection, colic flank pain, and hematuria. If hutch diverticulum comes into existence, it will enlarge with every-time voiding. Indications for operation are dependent on complications from it or suspicious of malignant changes. Size of diverticulum and its anatomical complexities mainly determine the intricacies of the surgery. In our experiences, robotic-assisted surgery provides several advantages over open and laparoscopic ones.