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 motility disorder - as in the present case. Left untreated, esophageal diverticula may be complicated by recurrent inflammation, fistula formation and malignancy. Preferred treatment is excision of the diverticulum and cardiomyotomy.
A series of operative views of excision of the diverticulum. The
esophagus has been mobilised and a tape passed around the esophagus,
orad to the diverticulum. The arrow A points to the pericardium, B to
the diverticulum and C to the collapsed lower lobe of the lung. A
staple gun is put across the neck of the diverticulum and it is
excised. The everted sac is shown. The procedure was completed by
performing a cardiomyotomy.
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