A 49-year old with a two-year history of dysphagia. At the time of
presentation it was taking him 20 minutes to eat a sandwich. The
contrast study shows a large diverticulum at the lower end of the
esophagus. It contains food residue. These findings were confirmed
endoscopically. Manometric studies were attempted, but the catheter
assembly could not be passed distal to the diverticulum. The upper
esophageal sphincter functioned normally.
Most of these epiphrenic diverticula are thought to be pulsion
diverticula which have arisen secondary to a motility disorder of the
esophagus. Many are asymptomatic and the patient tends to present with
problems related to the underlying motility disorder - as in the present
case, who had achalasia. Left untreated, esophageal diverticula may be
complicated by recurrent inflammation, fistula formation and malignancy. Preferred
treatment is excision of the diverticulum and cardiomyotomy.
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