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Dong X, Pan R, Duan L, Lu X, Cao D. MSCT study for adult esophageal diverticulum with secondary broncho-esophageal fistula. J Cardiothorac Surg 2024; 19:107. [PMID: 38409055 PMCID: PMC10898017 DOI: 10.1186/s13019-024-02510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Broncho-esophageal fistula (BEF) secondary to esophageal diverticulum is a rare clinical condition, which is often misdiagnosed for a long time. The aim of our study is to summarize and clarify the advantages of MSCT in diagnosing BEF secondary to esophageal diverticulum. METHODS We retrospectively analyzed patients clinically diagnosed with BEF from January 2005 to January 2022 at Jilin University First Hospital. Only those patients with BEF secondary to esophageal diverticulum and complete clinical data met our enrolled standard. All patients' clinicopathologic characteristics and MSCT features were systemically evaluated. RESULTS 17 patients were eligible for our cohort study, including male 10 and female 7. The patient's mean age was 42.3 ± 12.5. The chronic cough occurred in all seventeen patients and bucking following oral fluid intake was documented in nine patients. MSCT distinctly suggested the fistulous tract between the bronchi and the esophagus in all patients. The mean diameter of the orifices in the wall of the esophagus was 4.40 ± 1.81 mm. The orifice in the midthoracic esophagus side was 15 cases and 2 cases at the lower thoracic esophagus. The involved bronchus included 13 cases at the right lower lobe bronchus, 1 at the right middle lobe bronchus and 3 at the left lower lobe bronchus. The contrast agent was observed in the pulmonary parenchyma in 10 of 13 patients who underwent esophagogram. No definite fistula was observed in 3 of 11 who underwent gastroscopy, while the intra-operative findings supported the existence of fistula. CONCLUSIONS BEF secondary to esophageal diverticulum tends to occur between the midthoracic esophagus and the right lower lobe bronchus. Compared with esophagography and gastroscopy, MSCT shows more comprehensive information about the fistulous shape, size, course and lung involvement, which are helpful for establishing diagnosis and guiding subsequent treatment.
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Affiliation(s)
- Xin Dong
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Ruonan Pan
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Lijun Duan
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Xiaoqian Lu
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China
| | - Dianbo Cao
- Department of Radiology, the First Hospital of Jilin University, No. 71 of Xinmin Street, Changchun, Jilin, 130021, China.
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2
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Shintaku M. Esophageal intramural pseudodiverticulosis. World J Gastroenterol 2024; 30:137-145. [PMID: 38312118 PMCID: PMC10835521 DOI: 10.3748/wjg.v30.i2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a disease of unknown pathogenesis characterized by usually systemic, cystic dilatation of the excretory ducts of esophageal submucosal glands. In this article, I review the epidemiology, clinical manifestations, endoscopic findings, esophagographic findings, and histopathology of EIPD. I also discuss the etiology and possible pathogenesis of EIPD based on my experiences with this disease and a review of the literature. EIPD usually presents with dysphagia in middle-aged individuals. It is often complicated with secondary infections, most commonly candidiasis. On esophagography, EIPD is delineated as small, multiple, flask-shaped outward projections within the esophageal wall. In recent years, EIPD has been mainly diagnosed by endoscopic findings of multiple, localized, small mucosal depressions. The orifices of the "pseudodiverticula" periodically open and close, and excrete mucus onto the mucosal surface. On histopathological examination, the luminal surface of dilated ducts in EIPD is covered by multilayered, hyperplastic epithelial cells, but myoepithelial cells in the glandular acini are well preserved. Treatment of EIPD is usually symptomatic therapy, and prevention of the infectious complications is important. The etiology and pathogenesis of EIPD are largely unknown, but functional abnormalities of autonomic nerve fibers innervating the esophageal glands likely play an important role, since the structures of the glands are basically preserved in this disease.
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Affiliation(s)
- Masako Shintaku
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Hirakata 573-8511, Osaka, Japan
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3
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Kamboj AK, Chan A, Codipilly DC. Multiple Esophageal Diverticula in Achalasia. Mayo Clin Proc 2024; 99:102-103. [PMID: 38176817 DOI: 10.1016/j.mayocp.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Amrit K Kamboj
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Alex Chan
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - D Chamil Codipilly
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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4
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Gaber A, Fadloon I, Shehab H. Diverticular peroral endoscopic myotomy: management of a complex epiphrenic diverticulum. Endoscopy 2023; 55:E918-E919. [PMID: 37442179 PMCID: PMC10344611 DOI: 10.1055/a-2107-2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Abdelazeez Gaber
- Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Ismail Fadloon
- Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Hany Shehab
- Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
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5
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Aguirre Sánchez-Cambronero JA, Rodríguez-Bobada Caraballo D, Martínez Flores C, Sánchez-Manjavacas Muñoz N. Large symptomatic esophageal diverticulum. Rev Esp Enferm Dig 2023; 115:725-726. [PMID: 36896915 DOI: 10.17235/reed.2023.9518/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
A 72-year-old woman was referred from primary care to the gastroenterology clinic because of heartburn and occasional dysphagia for the last 8 years, with some isolated food regurgitation events and no other warning signs; she is currently asymptomatic on omeprazole. Gastroscopy revealed a dilated esophagus and food remnants with inability to reach the gastric lumen, which led to the suspicion of achalasia. The study was completed with pH-metry, which found no pathological reflux; esophageal manometry, with absence of esophageal motor abnormalities; and barium swallow, which revealed a large diverticulum on the posterior wall of the lower third of the esophagus, which had food remnants but no other changes or evidence of achalasia. Given these findings, a repeat gastroscopy was carried out that revealed a large diverticulum in the distal third of the esophagus that occluded 50 % of the esophageal lumen, with a length of 4-5 cm and abundant semi-liquid food remnants; upon aspiration of the latter a whitish mucosa with erythematous areas was revealed, as well as a 1.5-cm sliding hiatal hernia. No changes were found on advancing to the second duodenal portion. In view of the above findings and symptoms, the patient was referred to the surgery department to be evaluated for diverticulectomy.
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6
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Kim SY. Epiphrenic esophageal diverticulum: an uncommon cause of upper gastrointestinal bleeding. Korean J Intern Med 2023; 38:777-778. [PMID: 37211767 PMCID: PMC10493443 DOI: 10.3904/kjim.2023.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 05/23/2023] Open
Affiliation(s)
- Sang Yoon Kim
- Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
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7
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Zhang Y, Ji L, An F, Zhu X, Zhou Z, Zhan Q, Zhang G. A superficial esophageal cancer with a diverticulum cured by endoscopic submucosal dissection. Rev Esp Enferm Dig 2023; 115:408-409. [PMID: 37314130 DOI: 10.17235/reed.2023.9556/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Esophageal diverticulum are rare. However, Esophageal cancer that involves diverticula is relatively rare. Here we reported a rare case of a superficial esophageal cancer with an esophageal diverticulum, which was invisible before the endoscopic submucosal dissection. The cancer was successfully removed by ESD with no perforation.
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Affiliation(s)
- Yunan Zhang
- Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, China
| | - Lin Ji
- Gastroenterology , The Affiliated Wuxi People's Hospital of Nanjing Medical University
| | - Fangmei An
- Department of Gastroenterology , the Affiliated Wuxi People's Hospital of Nanjing Medical University,
| | - Xianlan Zhu
- Gastroenterology , The Affiliated Wuxi People's Hospital of Nanjing Medical University
| | - Zhiyi Zhou
- Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University
| | - Qiang Zhan
- Gastroenterology , The Affiliated Wuxi People's Hospital of Nanjing Medical University
| | - Guoqiang Zhang
- Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University
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8
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Argüelles Estrada P, Fernández Cadenas F, Giganto Tomé F, Lamas Álvarez S, López Mourelle A, Fraile López M. Over-The-Scope clip closure of an acquired bronchoesophageal fistula secondary to an esophageal diverticulum. Rev Esp Enferm Dig 2023; 115:272-273. [PMID: 36148689 DOI: 10.17235/reed.2022.9176/2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Esophagorespiratory fistula is a rare entity that occurs as a result of malignant and non-malignant causes. This condition is associated with high morbidity and mortality. Surgical repair has traditionally been the most common treatment and self-expandable metal stent are the first choice among non-surgical techniques. Here, we report a non-malignant bronchoesophageal fistula secondary to an esophageal diverticulum that was successfully closed using an over-the-scope clip.
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9
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Wang Y, Mi J, Zhao D. Congenital esophageal diverticulum with bronchoesophageal fistula treated with diverticular peroral endoscopic myotomy. Dig Endosc 2023; 35:e20-e21. [PMID: 36398474 DOI: 10.1111/den.14462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/23/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Yating Wang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianwei Mi
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongqiang Zhao
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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10
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Abstract
Objective Esophageal diverticulum is rare, and the concomitance of esophageal motility disorders (EMDs) and the efficacy of novel endoscopic treatment have not been investigated in Japan. Methods An examination including high-resolution manometry (HRM) was performed for patients with both EMDs and epiphrenic diverticulum. EMD-related epiphrenic diverticulum and Zenker's diverticulum were treated using salvage peroral endoscopic myotomy (s-POEM) and endoscopic diverticulotomy, respectively. Results Six cases of epiphrenic diverticulum were diagnosed in this study. Among 125 patients with achalasia and spastic disorders, concomitant epiphrenic diverticulum was observed in 4 (3.2%). Of these, three showed a normal lower esophageal sphincter pressure on HRM, although gastroscopy and esophagography revealed typical findings of an impaired lower esophageal sphincter relaxation. These four patients were successfully treated with s-POEM, and the Eckardt score improved from 6.3 to 0.25 at 32.5 (range: 13-56) months of follow-up, with equivalent treatment efficacy to that observed for achalasia and spastic disorders without epiphrenic diverticulum. In contrast, the two remaining cases of epiphrenic diverticulum had normal esophageal motility. Six cases of Zenker's diverticulum were diagnosed, and endoscopic diverticulotomy was successfully performed in all. The dysphagia score decreased from 2.8 to 0.17 at 14.8 (range: 2-36) months of follow-up. Overall, 12 endoscopic treatments were performed for esophageal diverticulum; no adverse events were observed. Conclusion In epiphrenic diverticulum patients, concomitant EMDs are not rare and should be carefully diagnosed. A normal lower esophageal sphincter pressure on HRM does not always mean a normal lower esophageal sphincter relaxation. S-POEM and endoscopic diverticulotomy are effective minimally invasive treatment options for EMD-related epiphrenic diverticulum and Zenker's diverticulum.
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Affiliation(s)
- Hiroki Sato
- Division of Gastroenterology, Niigata University Faculty of Medical Graduate School of Medical and Dental Science, Japan
| | - Manabu Takeuchi
- Division of Gastroenterology, Nagaoka Red Cross Hospital, Japan
| | - Kazuya Takahashi
- Division of Gastroenterology, Niigata University Faculty of Medical Graduate School of Medical and Dental Science, Japan
| | - Ken-Ichi Mizuno
- Division of Gastroenterology, Niigata University Faculty of Medical Graduate School of Medical and Dental Science, Japan
| | - Koichi Furukawa
- Division of Gastroenterology, Niigata City General Hospital, Japan
| | - Akito Sato
- Division of Gastroenterology, Nagaoka Chuo General Hospital, Japan
| | - Nao Nakajima
- Division of Gastroenterology, Niigata University Faculty of Medical Graduate School of Medical and Dental Science, Japan
| | - Junji Yokoyama
- Division of Gastroenterology, Niigata University Faculty of Medical Graduate School of Medical and Dental Science, Japan
| | - Shuji Terai
- Division of Gastroenterology, Niigata University Faculty of Medical Graduate School of Medical and Dental Science, Japan
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11
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Sommer R, Machado Grossi JV, Grossi Harada GR, Seabra MK, Cavazzola LT, Seabra AP. Treatment of Giant Esophageal Epiphrenic Diverticulum Using Robotic-Assisted Surgery. CRSLS 2021; 9:CRSLS.2021.00068. [PMID: 36016814 PMCID: PMC9387394 DOI: 10.4293/crsls.2021.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Epiphrenic diverticulum is a rare condition associated with esophageal motor disorder, and it is often asymptomatic, with a well-established surgical indication. The present study aims to report a case of a giant epiphrenic diverticulum in a 68-year-old male patient who, due to the symptoms, opted for surgical treatment using the daVinci® system. Robotic surgery consisting of esophageal diverticulectomy with cardiomyotomy was performed. The patient had an excellent recovery with an abbreviated hospitalization, return to food, and satisfactory routine activity.
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Affiliation(s)
- Renato Sommer
- Department of Surgery, Moinhos de Vento Hospital, Porto Alegre, Brazil
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12
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Zeng X, Bai S, Zhang Y, Ye L, Yuan X, Hu B. Peroral endoscopic myotomy for the treatment of esophageal diverticulum: an experience in China. Surg Endosc 2021; 35:1990-1996. [PMID: 32347387 DOI: 10.1007/s00464-020-07593-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the development of minimally invasive endoscopic approaches for the esophagus in recent years, peroral endoscopic myotomy (POEM) in the treatment of esophageal diverticulum has been described recently in some reports due to its successful outcomes. The aim of this study is to report our experience with the use of diverticular POEM (D-POEM) technique in the management of esophageal diverticulum. METHODS This retrospective study included consecutive patients with symptomatic esophageal diverticulum who visited our endoscopy center between April 2014 and January 2019. D-POEM was performed based on the principles of submucosal endoscopy. A new symptomatic scoring system was introduced to evaluate the severity of diverticular symptoms. RESULTS A total of 10 patients with esophageal diverticulum (Zenker's 2, mid-esophagus 5, and epiphrenic 3) were included. The overall technical success rate of D-POEM was 100%, with a mean procedure time of 38.9 ± 20.5 (range 16-70) min. No serious complications occurred. Clinical improvement was achieved in 90% (9/10) of patients. The symptomatic score was significantly decreased from 2.5 (IQR 2.00-3.25) to 1.0 (IQR 0-1.25) (P = 0.007) during a median follow-up period of 11.0 (IQR 10.25-17.25) months. CONCLUSION These findings suggested complete septotomy by D-POEM. Our preliminary data and experience put forwarded D-POEM as a safe and effective technique for esophageal diverticulum.
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Affiliation(s)
- Xianhui Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Shuai Bai
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Yuhang Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Liansong Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Xianglei Yuan
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China.
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13
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Qua CS, Saravannan K, Goh KL. Epiphrenic pulsion diverticulum: an uncommon cause of dysphagia and heartburn. BMJ Case Rep 2021; 14:e242920. [PMID: 33827890 PMCID: PMC8031012 DOI: 10.1136/bcr-2021-242920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Choon-Seng Qua
- Gastroenterology, Mahkota Medical Centre, Melaka, Malaysia
| | | | - Khean-Lee Goh
- Medicine, University of Malaya Faculty of Medicine, Kuala Lumpur, Malaysia
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14
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Kay MD, Morris-Wiseman LF, Caskey J, Winegar BA, Kuo PH. 99mTc-Sestamibi Scintigraphy Reveals Parathyroid Adenoma Masquerading as Esophageal Diverticulum. Clin Nucl Med 2021; 46:e159-e161. [PMID: 33208619 DOI: 10.1097/rlu.0000000000003399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 74-year-old woman with primary hyperparathyroidism diagnosed from routine laboratory tests described symptoms of fatigue and difficulty with concentration. During surgical consultation, the cervical and thoracic spine MRI scans from the preceding 10-year period, performed for relapsing-remitting multiple sclerosis, were reviewed. In this clinical context, the slowly enlarging left upper paraesophageal lesion, reported as a lateral proximal esophageal (Killian-Jamieson) diverticulum, was reevaluated for a potential parathyroid adenoma. 99mTc-sestamibi SPECT/CT demonstrated focal uptake in the paraesophageal lesion with surgical resection, confirming it to be a large parathyroid adenoma.
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Affiliation(s)
- Matthew D Kay
- From the Department of Medical Imaging, College of Medicine
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15
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Stašek M, Neoral Č, Zhydkov R, Vrba R, Aujeský R. Current possibilities of minimally invasive therapy of oesophageal diverticula. ACTA ACUST UNITED AC 2020; 99:152-158. [PMID: 32545977 DOI: 10.33699/pis.2020.99.4.152-158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Oesophageal diverticula represent a relatively rare pathology of the oesophagus requiring a specific diagnostic and therapeutic approach. Interventional therapy is indicated for symptomatic diverticula, diverticula with other pathologies (tumour in the diverticulum, gastroesophageal reflux disease, low-malignancy gastroesophageal junction tumours). The open surgical approach is being increasingly replaced by minimally invasive surgical, endoscopic and combined methods. Surgical mini-invasive methods use transaxillary, thoracoscopic or transhiatal laparoscopic approach, often with endoscopic assistance. Endoscopic and transoral surgical procedures include various diverticulotomy techniques and submucosal tunnelling techniques (variants of peroral endoscopic myotomy). The primary concern in therapy is the reduction of symptoms, improvement of the quality of life and the patient´s safety. The resulting quality of life is affected by the frequent presence of functional diseases of the oesophagus (achalasia, hypercontractile oesophagus). Although surgical minimally invasive therapy using the laparoscopic or thoracoscopic approach is safe, it nevertheless does not exclude serious risk of complications. Randomized and observational studies comparing endoscopic and surgical methods are still missing. It is, therefore, necessary to extend the records in order to update the indication algorithm of intervention therapy, focusing mainly on safety with a clear imperative for patient centralization.
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16
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Affiliation(s)
- Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Correspondence to Gwang Ha Kim, M.D. Tel: +82-51-240-7869 Fax: +82-51-244-8180 E-mail:
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17
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Lee JK, Fynes MM. Esophagogastric Bypass to Improve Dysphagia in Patients With Achalasia and Epiphrenic Diverticulum. Radiol Technol 2019; 90:605-610. [PMID: 31270260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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18
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Spontaneous mediastinal abscess of curious causation. J Paediatr Child Health 2019; 55:874-5. [PMID: 31270871 DOI: 10.1111/jpc.2_14486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
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19
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Olivier R, Wallenhorst T, Coron E, Brochard C. Esophageal diverticulum after peroral endoscopic myotomy: Think about it if the symptoms change. Dig Liver Dis 2019; 51:908. [PMID: 30826277 DOI: 10.1016/j.dld.2019.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Raphael Olivier
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France; Université de Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Université Bretagne Loire, Nantes, France
| | - Timothée Wallenhorst
- Service des Maladies de l'Appareil Digestif, CHU Rennes Pontchaillou, Rennes, France
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France; Université de Nantes, INSERM, IMAD, The Enteric Nervous System in Gut and Brain Disorders, Université Bretagne Loire, Nantes, France
| | - Charlène Brochard
- Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hôpital Hôtel-Dieu, Nantes, France; Service des Maladies de l'Appareil Digestif, CHU Rennes Pontchaillou, Rennes, France; Service d'Explorations Fonctionnelles Digestives, CHU Rennes Pontchaillou, Rennes, France; Université de Rennes 1, CIC1414, groupe INPHY, CHU Rennes Pontchaillou, Rennes, France.
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20
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Abstract
RATIONALE Most of the esophageal diverticulums are congenital traction instead of in childhood. In most conditions, esophageal diverticulums are free of any symptoms. As one of the rare entity, esophageal diverticulum can also result in bronchoesophageal fistula. PATIENT CONCERNS A 10-year-old girl was admitted due to a 2-month history of cough and choking after drinking, and fever for 3 days. No symptoms when taking solid food were found. DIAGNOSES By esophagogram, 3-dimensional computed tomography and esophagoscopy, an esophageal diverticulum was demonstrated in the middle esophagus with a bronchoesophageal fistula visualized. Then the diagnoses of esophageal diverticulum and bronchoesophageal fistula were established. INTERVENTIONS A regular trans-anterolateral thoracotomy was carried out under general anesthesia with patient lying on the right side. The diverticulum was then removed and the fistulous tract was closed. OUTCOMES The girl discharged on the 14th postoperative day and received a regular monthly follow-up, at present, no recurrence was found. LESSONS Bronchoesophageal fistula may be a complication of esophageal diverticula, and should be considered in cases of unexplained cough or recurrent pneumonia.
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Affiliation(s)
- Zhi-Ming Wang
- Department of Oral and Maxillofacial Surgery Department of Pediatric Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, P.R. China
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Krenyov KY, Chubar IV, Prokopyuk OV. [CLINICAL OBSERVATION OF THE ESOPHAGEAL DIVERTICULUM COMPLICATION]. Klin Khir 2017:63-64. [PMID: 30277354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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22
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Børgager M, Andos S, Durup J, Licht PB. [Epiphrenic oesophageal diverticulum with an oesophagobronchial fistula resulting in a lung abscess]. Ugeskr Laeger 2016; 178:V07160523. [PMID: 27908313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Epiphrenic oesophageal diverticula are rare and often asymptomatic. In this case report a 58-year-old woman was diagnosed with an epiphrenic oesophageal diverticulum, which developed an oesophagobronchial fistula leading to a pulmonary abscess in the right lower lobe, septicaemia and acute respiratory failure. The patient underwent right lower lobectomy and the diverticulum was stapled off the oesophagus. The post-operative course was uneventful. This complication is only rarely described previously.
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Silva M, Rodrigues M, Peixoto A, Ramalho R, Macedo G. Congenital epiphrenic diverticulum: a rare bronchopulmonary foregut malformation. Gastrointest Endosc 2016; 84:197-8. [PMID: 26706780 DOI: 10.1016/j.gie.2015.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/09/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Marco Silva
- Department of Gastroenterology, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Márcio Rodrigues
- Department of Radiology, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Armando Peixoto
- Department of Gastroenterology, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rosa Ramalho
- Department of Gastroenterology, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Department of Gastroenterology, Centro Hospitalar São João, Faculty of Medicine of the University of Porto, Porto, Portugal
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Abstract
A rare case of esophagopleural fistula following spontaneous rupture of a traction diverticulum of the esophagus in a 25-year-old man was successfully treated by diverticulectomy.
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Affiliation(s)
- Vijay Agarwal
- Department of Thoracic and Cardiovascular Surgery, King George Medical College and Hospital, Lucknow 226-003, India
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Affiliation(s)
- Chin Yit Soo
- University of Edinburgh, Edinburgh, United Kingdom
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Abstract
BACKGROUND esophageal diverticula are classified as 2 types: true diverticula and pseudodiverticula. These disorders result in clinical manifestations such as dysphagia and esophageal reflux. In this study, we evaluated the results of surgical treatment for diverticula. METHODS all patients suffering from symptomatic esophageal diverticulum, who underwent surgical treatment in Ghaem Hospital from 2000 to 2012 and were followed up for at least for one year, were included in the study. Age, sex, clinical manifestations, location, surgical approach, and mortality were evaluated. There were 25 patients (15 men and 10 women) with a mean age of 41 ± 8.3 years. RESULTS the most common site of involvement was inferior (epiphrenic diverticulum). Barium swallow was diagnostic. After surgical treatment, complications occurred in 4 (16%) patients, comprising anastomosis site leakage, hoarseness, atelectasis, and wound infection; all were treated medically. There was no postoperative mortality. All patients experienced an improvement in symptoms during one year of follow-up. CONCLUSION due to the good results and minimal complications postoperatively, surgical treatment is recommended for patients with symptomatic esophageal diverticulum.
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Affiliation(s)
- Reza Bagheri
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ghodratollah Maddah
- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadtaghi Rajabi Mashhadi
- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ziaollah Haghi
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Tavassoli
- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Javad Ghamari
- Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Sheibani
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Affiliation(s)
- Osamu Nagashima
- Division of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Japan.
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29
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Cui W, Fan F, Zhang D, Garnett D, Tilzer L. Primary composite lymphoma of the larynx, composed of diffuse large B-cell lymphoma and peripheral T-cell lymphoma, not otherwise specified, presenting as left subglottic tracheal fistula, esophageal diverticulum, and neck abscess. Ann Clin Lab Sci 2012; 42:73-80. [PMID: 22371913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Primary laryngeal lymphoma occurs very rarely, accounting for far less than 1% of primary malignant laryngeal neoplasms. To the best of our knowledge, primary laryngeal composite lymphoma has not been reported in the literature. Herein, we report the first case of primary laryngeal composite lymphoma composed of diffuse large B-cell lymphoma (DLBCL) and peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS), in a 43-year-old man. Of special interest is the patient's unique clinical presentation of left subglottic tracheal fistula, esophageal diverticulum, and neck abscess with no discrete mass identified. We describe the clinical and pathological characteristics of this case and review the literature.
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MESH Headings
- Abscess/complications
- Abscess/diagnosis
- Abscess/diagnostic imaging
- Adult
- Composite Lymphoma/complications
- Composite Lymphoma/diagnosis
- Composite Lymphoma/diagnostic imaging
- Composite Lymphoma/pathology
- Diagnosis, Differential
- Diverticulum, Esophageal/complications
- Diverticulum, Esophageal/diagnosis
- Diverticulum, Esophageal/diagnostic imaging
- Fatal Outcome
- Glottis/diagnostic imaging
- Glottis/pathology
- Humans
- Immunohistochemistry
- In Situ Hybridization
- Laryngeal Neoplasms/complications
- Laryngeal Neoplasms/diagnosis
- Laryngeal Neoplasms/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, T-Cell, Peripheral/complications
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/diagnostic imaging
- Lymphoma, T-Cell, Peripheral/pathology
- Male
- Neck/diagnostic imaging
- Neck/pathology
- Respiratory Tract Fistula/complications
- Respiratory Tract Fistula/diagnosis
- Respiratory Tract Fistula/diagnostic imaging
- Staining and Labeling
- Tomography, X-Ray Computed
- Trachea/diagnostic imaging
- Trachea/pathology
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Affiliation(s)
- Wei Cui
- Department of Pathology and Laboratory Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA.
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30
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Abstract
BACKGROUND Killian-Jamieson diverticulum (KJD) is a rare esophageal diverticulum that protrudes through the muscular gap in the anterolateral wall of the proximal cervical esophagus inferior to the cricopharyngeus. Although several patients with bilateral KJD have been reported, high-resolution ultrasound (US) image of bilateral KJD has never been reported. SUMMARY A 71-year-old man visited our hospital for annual follow-up of known thyroid nodules. In addition to the previously noted thyroid nodules, two arc-shaped hyperechoic lesions with reverberation artifacts, which suggested air-containing lesions, were unexpectedly seen posterior to bilateral thyroid lobes. Although the connection between the esophagus and the lesions was not definitely visible on US, our first differential diagnosis was esophageal diverticula. They were confirmed to be bilateral KJD on the following pharyngoesophagography. CONCLUSIONS If US features are not enough to differentiate esophageal diverticulum from suspicious thyroid nodule, pharyngoesophagography can be performed instead of invasive fine-needle aspiration to obtain a definite diagnosis of incidentally detected esophageal diverticulum.
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Affiliation(s)
- Myung Hyun Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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31
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Mercantini P, Virgilio E, Petrucciani N, Pardi M, Sebastiani S, Sagnotta A, Sforza N, Ziparo V. Giant midthoracic pulsion diverticulum of the esophagus. Am Surg 2010; 76:782-784. [PMID: 20698395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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32
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Pasha Y, Blunt D, Kennedy PTF. The pea, the yeast and the prostate. QJM 2010; 103:265-6. [PMID: 19903726 DOI: 10.1093/qjmed/hcp160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Pasha
- Department of Gastroenterology, Charing Cross Hospital, Fulham Palace Road, London, UK.
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Hoshino M, Omura N, Yano F, Tsuboi K, Matsumoto A, Kashiwagi H, Yanaga K. Laparoscopic Heller myotomy and Dor fundoplication combined with laparoscopic diverticular introversion suturing for achalasia complicated by epiphrenic diverticulum: report of a case. Surg Today 2010; 40:158-61. [PMID: 20107957 DOI: 10.1007/s00595-009-4021-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 05/08/2009] [Indexed: 11/28/2022]
Abstract
A 41-year-old woman was admitted due to dysphagia and weight loss of 6 kg. An upper gastrointestinal radiographic contrast study demonstrated an S-shaped lower esophagus with a peak transverse diameter of 65 mm. Moreover, an epiphrenic diverticulum was also detected in the lower part of the esophagus (50 x 40 mm). The measurement of intraesophageal pressure showed a lower esophageal sphincter pressure of 80 mmHg and a lower esophageal sphincter length of 31 mm. Esophageal clearance assessment via a timed barium esophagogram demonstrated impaired contrast clearance, with a rate of 26% at 5 min. A laparoscopic Heller myotomy, Dor fundoplication, and diverticular introversion suturing were performed. The postoperative course was uneventful and the patient was discharged on day 4. At the 2-year follow-up, no dysphagia was present. This is the first report of a laparoscopic diverticuloplasty using an introversion buried suture with a Heller myotomy and Dor fundoplication for achalasia complicated by an epiphrenic diverticulum.
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Affiliation(s)
- Masato Hoshino
- Department of Surgery, Daisan Hospital, Jikei University School of Medicine, 4-11-1 Izumihoncho, Komae, Tokyo, Japan
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34
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35
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Mullady DK, Harrison JR. Clinical challenges and images in GI. Perforated diverticulum with neck abscess. Gastroenterology 2007; 132:1655, 2083. [PMID: 17484861 DOI: 10.1053/j.gastro.2007.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Daniel K Mullady
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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36
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Berindoague R, Targarona E, Pala X, Balagué C, Martinez C, Hernandez P, Agusti A, Sallent E, Mones J, Trias M. Unusual upper gastrointestinal diseases associated with achalasia: laparoscopic approach. Surg Endosc 2007; 21:719-23. [PMID: 17242987 DOI: 10.1007/s00464-006-9056-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 06/20/2006] [Accepted: 06/30/2006] [Indexed: 01/18/2023]
Abstract
BACKGROUND As a result of the high success rate associated with the laparoscopic approach for achalasia, surgery for the disease has become the treatment of choice in recent years. With the greater number of patients undergoing surgery, surgeons may encounter other upper gastroesophageal illnesses associated with achalasia, and these may require evaluation for simultaneous surgical treatment. This study aimed to evaluate the incidence of gastroesophageal diseases associated with achalasia, and to determine the possibility for simultaneous management using the laparoscopic approach. METHODS From January 1999 to May 2006, 81 patients were referred from the Service of Gastroenterology to the Service of General and Digestive Surgery as candidates for the surgical management of achalasia. Data for this group were recorded prospectively in laparoscopic surgery databases at the Hospital Sant Pau and the Hospital de Igualada. A total of 78 patients underwent laparoscopic Heller myotomy with gastric fundoplication. RESULTS In 8 of 81 patients, nine additional gastroesophageal diseases (11.1%) were found: three cases of pseudoachalasia (3.7%), three cases of paraesophageal hiatal hernia (3.7%), two cases of esophageal diverticulum (2.5%), and one case of gastric volvulus (1.2%). Pseudoachalasia was diagnosed for three patients. The diagnosis was made preoperatively for one of these patients. For the other two patients, an adenocarcinoma arising from the gastroesophageal junction was diagnosed during the laparoscopy. In three cases, a paraesophageal hiatal hernia was found and treated by laparoscopic Heller myotomy, sac excision, hiatal closure, and posterior fundoplication. Esophageal diverticulectomy was performed for one patient. Another patient presented with an organoaxial gastric volvulus associated with achalasia, for which laparoscopic Heller myotomy, posterior fundoplication, and anterior gastropexy were performed. The median follow-up period was 39 months, with no recurrence. CONCLUSIONS Despite their infrequency, several gastroesophageal diseases may be found in association with achalasia. Laparoscopic surgery may be useful for the diagnosis and/or treatment of both diseases.
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Affiliation(s)
- R Berindoague
- Service of General and Digestive Surgery, Hospital San Pau, Barcelona, Spain.
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37
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Affiliation(s)
- Khurram Rashid
- Division of Nuclear Medicine and Department of Thoracic Surgery, Danbury Hospital, Danbury, Connecticut 06810, USA
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38
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Dey S, Good E, Morady F, Oral H. Images in cardiovascular medicine. Esophageal diverticulum illustrated by barium swallow during left atrial catheter ablation for atrial fibrillation. Circulation 2006; 114:e597. [PMID: 17116775 DOI: 10.1161/circulationaha.106.638403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sujoya Dey
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich, USA
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39
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Pacheco Galván A, García Gutiérrez V, Pérez González E. [Necrotizing pneumonitis due to fistulation from the esophageal diverticulum]. Arch Bronconeumol 2006; 42:611-2. [PMID: 17125699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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40
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Motoyama S, Maruyama K, Okuyama M, Sasaki K, Sato Y, Ogawa JI. Laparoscopic Long Esophagomyotomy with Dor's Fundoplication Using a Transhiatal Approach for an Epiphrenic Esophageal Diverticulum. Surg Today 2006; 36:758-60. [PMID: 16865526 DOI: 10.1007/s00595-006-3221-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 01/17/2006] [Indexed: 10/24/2022]
Abstract
The conventional treatment for an epiphrenic diverticulum consists of diverticulectomy with or without myotomy via a left thoracic approach. We describe the resection of an epiphrenic esophageal diverticulum using a laparoscopic transhiatal approach after observing its rate of enlargement on routine chest X-rays done over a number of years. This approach eliminates the need for thoracotomy and pleural drainage, and permits a complete laparoscopic procedure, including diverticulectomy, myotomy, and antireflex surgery.
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Affiliation(s)
- Satoru Motoyama
- Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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41
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Affiliation(s)
- C V Feo
- Unit of General Surgery, Department of Surgery, Anesthesiology and Radiology, University of Ferrara, Ferrara, Italy.
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Abstract
PURPOSE To report the frequency and spectrum of use of the potassium titanyl phosphate (KTP) laser in a tertiary referral pediatric otolaryngology practice and to focus on a novel use for the KTP laser which has not previously been described in the literature. DESIGN A retrospective chart review of the operative log database of a pediatric otolaryngologist in a tertiary referral setting over a seven year period. RESULTS Out of 2886 cases, a total of 49 (1.7%) involved the use of the KTP laser. These included 7 otologic cases, 3 laryngeal cases, 31 subglottic/tracheal cases, 1 esophageal case and 7 nasal cases. One of these cases involved a previously unreported use of the KTP laser, closure of a tracheo-esophageal fistula (TEF). CONCLUSION The KTP laser is an important operative tool in pediatric otolaryngology and new uses for this laser continue to emerge. One of these, KTP closure of a TEF offers pediatric otolaryngologists the potential for significant changes in management of this congenital problem with reduced surgical morbidity. Familiarity with the KTP laser and expertise in its use and applications is essential in providing state-of-the-art care to pediatric otolaryngology patients in a tertiary referral center.
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Affiliation(s)
- Stacey L Ishman
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Johns Hopkins University, Baltimore, MD, USA
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Zhao J, Liao Y, Gao S. Right aortic arch with retroesophageal left ligamentum arteriosum. Tex Heart Inst J 2006; 33:218-21. [PMID: 16878631 PMCID: PMC1524719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A 49-year-old woman with a 2-year history of severe dysphagia, claudication of the right arm, and persistent pulsatile back pain presented at our institution. An esophagogram showed 2 marked indentations of the upper esophagus. Computed axial tomography showed a right-sided aortic arch with mirror image branching and an aortic diverticulum; the thoracic aorta distal to the origin of the right subclavian artery was elongated and tortuous, ascending to the base of the neck to form the "2nd arch", which compressed the right-arm plexus nerve and the upper vertebral column. Through a right thoracotomy, a segment of thoracic aorta around the Kommerell's diverticulum was resected, and the proximal and distal ends of the thoracic aorta were reapproximated. The patient tolerated the procedure well and remained symptom free.
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Affiliation(s)
- Jinping Zhao
- Department of Cardiothoracic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, 430030 Wuhan, People's Republic of China.
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Abstract
Unusual features of iodine-131 uptake during thyroid cancer scintigraphy may lead to a false-positive diagnosis of residual or recurrent malignancy and associated metastasis. Radiographic or cross-sectional imaging correlation should help to differentiate truly functioning thyroid lesions from physiological or artifactual tracer accumulation. The authors present a case of iodine-131 mediastinal uptake from an esophageal epiphrenic diverticulum.
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Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA.
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Hassan W, Omrani AA, Neimatallah M, Fadley FA, Halees ZA. Dysphagia lusoria caused by aberrant right subclavian artery, Kommerell's diverticulum, legamentum ring, right descending aorta, and absent left pulmonary artery: a report of a unique vascular congenital disease undetected until adulthood and a review of the literature. Pediatr Cardiol 2005; 26:851-5. [PMID: 16088417 DOI: 10.1007/s00246-005-0936-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
An active otherwise healthy and middle-aged woman presented with left supraclavicular pulsation, right upper extremity claudication, and mild dysphagia. Evaluation revealed an aberrant right subclavian artery, Kommerell's diverticulum with aneurysmal degeneration, legamentum arteriosum completing vascular ring, and absent left pulmonary artery with multiple collateral supply to the left lung. She underwent successful surgical repair via right thoracotomy, including division of the vascular ring, resection of the diverticulum and aneurysm, and finally reimplantation of the right subclavian artery to the aortic arch. Her symptoms resolved completely, and she was able to resume normal activities.
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Affiliation(s)
- W Hassan
- King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh, 11211, Saudi Arabia.
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Mercer D, Blachar A, Khafif A, Weiss J, Kessler A. Real-time sonography of Killian-Jamieson diverticulum and its differentiation from thyroid nodules. J Ultrasound Med 2005; 24:557-560. [PMID: 15784775 DOI: 10.7863/jum.2005.24.4.557] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Diego Mercer
- Department of Radiology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
There have so far been few reports on esophageal diverticulum in children. We experienced two symptomatic pediatric cases with esophageal diverticulum. Our cases manifested high fever and dysphagia with chest pain during swallowing. The patients underwent endoscopic diverticulotomy. The septum between the diverticulum and the esophagus was cut using the argon plasma coagulation (APC 3000) system. We recommend an endoscopic diverticulotomy as an effective treatment modality for such symptomatic cases.
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Affiliation(s)
- Y Nishimoto
- Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan
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48
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Affiliation(s)
- Natsuko Tatsumi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 456 Kajii-cho, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, Kyoto 604-0911, Japan.
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49
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Affiliation(s)
- Han-Mo Chiu
- National Taiwan University Hospital, Taipei, Taiwan
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50
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Abstract
Esophageal diverticula are classified by location-phrenoesophageal (Zenker's diverticulum-70%), thoracic and mediastinal (10%), and epiphrenic (20%). Almost all esophageal diverticula are acquired pulsion diverticula. The most common symptoms are dysphagia, regurgitation, thoracic pain, and pulmonary manifestations related to aspiration. Barium swallow and upper endoscopy will help to establish the diagnosis while esophageal manometry may reveal underlying dysmotility. Diverticula should not be treated unless they are symptomatic. The treatment of Zenker's diverticulum is surgical and consists of either diverticulectomy or diverticular suspension with a myotomy of the cricopharyngeus muscle via cervical approach. Transoral endoscopic stapled diverticulostomy is a new and simple approach which may become the treatment of choice, particularly in elderly and high-risk patients. Treatment of diverticula of the mid and low esophagus must take into account any motor anomalies or associated lesions. Diverticulectomy with esophageal myotomy and an anti-reflux procedure through a left thoracotomy is the standard approach, but endoscopic approaches seem feasible, particularly for epiphrenic diverticula, and may become the norm in years to come.
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Affiliation(s)
- N Carrère
- Service de Chirurgie Générale et Digestive, CHU Toulouse-Purpan - Toulouse
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