Surgical Management of Two Simultaneously Occurring Epiphrenic Esophageal Diverticula

Abstract

Among all diverticula of the esophagus, epiphrenic diverticula occur less frequently than those in the pharyngo-esophageal segment. Two simultaneously occurring diverticula in the epiphrenic esophagus are very rarely reported in the English literature. A 52-year-old woman had a 3-year history of troublesome dysphagia, heartburn, chest pain and cough. Initial investigation included a physical examination and a barium swallow, which showed the presence of two diverticula in the epiphrenic esophagus. Esophagoscopy confirmed the presence only of the lower diverticulum. The patient underwent a left thoracotomy, the esophagus was mobilised from the hiatus to the aortic arch. The necks of the diverticula were localised in the posterior wall and between them there was a bridge of circular muscular fibres, which was divided. Diverticulectomy over an intra-esophageal 54 F Maloney dilator was performed. The upper diverticulum was left intact because it disappeared after the bridge of esophageal muscles has been myotomized. A long myotomy was carried out, and a modified Belsey fundoplication was added. The postoperative course was uneventful, and the patient remains well at 10 years with no recurrence of symptoms.

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M. Migliore, G. Pulvirenti, D. Calvo, A. Criscione, M. Gangemi, F. Borrata and D. Palumbo, "Surgical Management of Two Simultaneously Occurring Epiphrenic Esophageal Diverticula," Open Journal of Thoracic Surgery, Vol. 2 No. 4, 2012, pp. 91-93. doi: 10.4236/ojts.2012.24018.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] N. K. Altorki, M. Sunagawa and D. B. Skinner, “Thoracic Oesophageal Diverticula. Why Is Operation Necessary?” The Journal of Thoracic and Cardiovascular Surgery, Vol. 105, No. 2, 1993, pp. 260-264.
[2] R. Rosati, U. Fumagalli, S. Bona, L. Bonavina and A. Peracchia, “Diverticulectomy, Myotomy, and Fundoplication through Laparoscopy: A New Option to Treat Epiphrenic Esophageal Diverticula?” Annals of Surgery, Vol. 227, No. 2, 1998, pp. 174-178. doi:10.1097/00000658-199802000-00004
[3] J. C. Benacci, C. Deschamps, V. F. Trastek, M. S. Allen, R. C. Daly and P. C. Pairolero, “Epiphrenic Diverticulum: Results of Surgical Treatment,” The Annals of Thoracic Surgery, Vol. 55, No. 5, 1993, pp. 1109-1113. doi:10.1016/0003-4975(93)90016-B
[4] E. Avisar and J. D. Luketich, “Adenocarcinoma in a Mid-Esophageal Diverticulum,” The Annals of Thoracic Surgery, Vol. 69, No. 1, 2000, pp. 288-289. doi:10.1016/S0003-4975(99)01201-1
[5] M. Migliore and M. Signorelli, “Episodic Abdominal and Chest Pain in a Young Adult,” JAMA, Vol. 307, No. 16, 2012, pp. 1746-1747. doi:10.1001/jama.2012.506
[6] S. C. Clark, S. A. Norton, K. Jeyasingham and P. D. Ridley, “Oesophageal Epiphrenic Diverticulum: An Unusual Presentation and Review,” Annals of the Royal College of Surgeons of England, Vol. 77, No. 5, 1995, pp. 342-345.
[7] M. Migliore, H. Payne and K. Jeyasingham, “Pathophysiologic Basis for Operation of Zenker’s Diverticulum,” The Annals of Thoracic Surgery, Vol. 57, No. 6, 1994, pp. 1616-1620. doi:10.1016/0003-4975(94)90134-1
[8] M. Migliore, “The Upper Esophageal Sphincter and the Cricoesophageal Coordination,” Annali Italiani di Chirurgia, 2012, in Press.
[9] P. M. Fisichella, M. Pittman and P. C. Kuo, “Laparoscopic Treatment of Epiphrenic Diverticula: Preoperative Evaluation and Surgical Technique. How I Do It,” Journal of Gastrointestinal Surgery, Vol. 15, No. 10, 2011, pp. 1866-1871. doi:10.1007/s11605-011-1631-6
[10] M. Migliore, M. Arcerito, A. Vagliasindi, R. Puleo, F. Basile and G. Deodato, “The Place of Belsey Mark IV Fundoplication in the Era of Laparoscopic Surgery,” European Journal of Cardiothoracic Surgery, Vol. 24, No. 4, 2003, pp. 625-630. doi:10.1016/S1010-7940(03)00445-7
[11] M. Migliore and K. Jeyasingham, “Re-Operations for Failed Anti-Reflux Surgery. Lessons from the Past and Prospects for the Future,” Annali Italiani di Chirurgia, Vol. 80, No. 4, 2009, pp. 267-274.
[12] M. Migliore, “Reoperation for Failed Antireflux Surgery,” Multimedia Manual of Cardio-Thoracic Surgery, Vol. 2011, No. 0311, 2011. doi:10.1510/mmcts.2009.004226
[13] M. L. Thomas, A. A. Anthony, B. G. Fosh, J. G. Finch and G. J. Maddern, “Oesophageal Diverticula,” British Journal of Surgery, Vol. 88, No. 5, 2001, pp. 629-642. doi:10.1046/j.1365-2168.2001.01733.x
[14] X. B. D’Journo, P. Ferraro, J. Martin, L. Q. Chen and A. Duranceau, “Lower Oesophageal Sphincter Dysfunction Is Part of the Functional Abnormality in Epiphrenic Diverticulum,” British Journal of Surgery, Vol. 96, No. 8, 2009, pp. 892-900. doi:10.1002/bjs.6652

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