Midthoracic esophageal diverticula

A Multidisciplinary Minimally Invasive Approach Is Necessary for the Contemporary Management of Esophageal Diverticula

Background: Esophageal diverticula were traditionally treated with open surgery, which is associated with significant morbidity and mortality rates. Management has shifted to minimally invasive approaches with several advantages. We examine outcomes in patients with esophageal diverticula treated with minimally invasive techniques by a multidisciplinary surgical team at a single center. Materials and Methods: A retrospective review of a prospectively maintained database was performed for patients who underwent minimally invasive surgery for esophageal diverticula at our institution from June 2010 to December 2022. Primary outcomes were 30-day morbidity and mortality rates. Secondary outcomes were symptom resolution, length of stay (LOS), readmission, and need for reintervention. Results: A total of 28 patients were identified. Twelve patients had pharyngeal diverticula, 7 patients had midesophageal diverticula, and 9 patients had epiphrenic diverticula. Thirty-day morbidity and readmission rates were 10.7% (3 patients), 1 pharyngeal (sepsis), 1 midesophageal (refractory nausea), and 1 epiphrenic (poor oral intake). There were no esophageal leaks. Average LOS was 2.3 days, with the pharyngeal group experiencing a significantly shorter LOS (1.3 days versus 3.4 days for midesophageal, P < .01 versus 2.8 days for epiphrenic, P < .05). Symptom resolution after initial operation was 78.6%. Reintervention rate was 17.9%, and symptom resolution after reintervention was 100%. There were no mortalities. Conclusion: This study demonstrates that esophageal diverticula can be repaired safely and efficiently when performed by a multidisciplinary team utilizing advanced minimally invasive endoscopic and robotic surgical techniques. We advocate for the management of this rare condition at a high-volume center with extensive experience in foregut surgery.

Mid-Esophageal Diverticulum Mimicking an Aortic Aneurysm on Chest Radiography

BACKGROUND

Mid-esophageal region is an uncommon location of esophageal diverticula, a condition usually diagnosed in elderly individuals.

CASE REPORT

We report a case of an elderly male with incidental finding of mediastinal lesion, which was initially thought to be an aortic aneurysm. Further evaluation demonstrated a mid-esophageal diverticulum at the level of the carina. We present patient's medical history and imaging, followed by a discussion on symptoms and management.

CONCLUSIONS

Knowledge of benign conditions that might mimic a mediastinal vascular pathology is important for therapeutic and prognostic reasons, as they are often managed conservatively.

The role of barium esophagography in an endoscopy world

Barium esophagography, although an old test, remains important to the understanding of esophageal physiology and diagnosis of esophageal disorders. It provides additive and/or confirmatory information to endoscopy and is the more accurate means of yielding diagnosis. Barium esophagography allows correlation of symptoms with barium findings and with varied textures substances. It allows, particularly for oropharyngeal dysfunction, implementation therapeutic maneuvers and instructions while testing. The caveat to maintaining the benefits of barium esophagography is continuing to promote and support expertise from our radiologists in performing these studies, which has been challenged by our cost-efficient and high-tech medical society.

Giant midoesophageal diverticulum--case report and review of the literature

INTRODUCTION

Midoesophageal diverticula >4cm in size are a medical rarity with a dozen reported cases so far. Usually, midoesophageal diverticula tend to be of small size and asymptomatic.

CASE REPORT

We herein present a case of a woman suffering from a midoesophageal diverticulum in a very large dimension--never described in the current literature before--who successfully underwent surgical resection via thoracotomy.

DISCUSSION

If symptomatic, common symptoms are dysphagia and regurgitation. The risk of malignant transformation is low. Treatment of midoesophageal diverticula is based on size and symptoms of the patient. Asymptomatic or small diverticula detected during routine endoscopy can be followed-up without further therapy, whereas symptomatic or large diverticula should be treated surgically by resection. Myotomy should be performed if any motility disorder is evident. Open as well as minimal invasive approach by thoracoscopical surgery is both feasible.

Frequency and etiology of midesophageal diverticula at barium esophagography

Midesophageal diverticula were identified at 8 of 218 (3.6%) esophagrams performed over a 3-year period in adult patients with no prior history of gastroesophageal surgery. All eight patients received a final diagnosis of esophageal dysmotility with secondary pulsion diverticula, and seven of eight (88%) patients had abnormal peristalsis noted during the esophagram. We conclude that most, if not all, midesophageal diverticula are pulsion in etiology, and the detection of a midesophageal diverticulum should prompt a careful search for underlying dysmotility.

Unusual case of a large midoesophageal diverticulum mimicking unstable angina pectoris

We describe a 77-year-old lady who presented with progressive retrosternal pain radiating to the left arm and the back. After exclusion of cardiac causes a large midoesophageal diverticulum was found on oesophago-gastro-duodenoscopy. Importantly, the retrosternal pain completely disappeared after endoscopic removal of impacted food from the diverticulum. After the surgical resection the patient became fully asymptomatic. This is the first example of angina-like chest pain which definitively resulted from a midoesophageal diverticulum. Therefore, midoesophageal diverticula should be considered as a rare differential diagnosis of exercise-induced retrosternal pain.