1/167. Perforated epiphrenic diverticulum treated by video laparoscopy. We describe the case of an esophageal perforation that occurred after an endoscopic examination for epigastric pain 11 days before being referred to our institution. After 5 days of conservative management with total parenteral nutrition, left chest drainage, and broad-spectrum antibiotics, we decided to perform an videolaparoscopic jejunostomy for feeding with distal esophageal exclusion and a cervical esophagostomy. In the operating room, however, we found that the site of the perforation was an epiphrenic diverticulum. Treatment was diverticulectomy through videolaparoscopy with manual and mechanic suture. The postoperative evolution was successful, and the patient was discharged 8 days after surgery. ( info) |
2/167. Intramural diverticulosis of the esophagus. A description is given of the etiology and pathology of intramural esophageal diverticulosis as so far discussed in the literature. In view of the course and the clinical findings in two young patients in whom this diagnosis was established, it is suggested that intramural diverticulosis develops as a result of a devolopmental disorder in the autonomic nervous system. ( info) |
3/167. Esophageal inflammatory pseudotumor associated with a pseudodiverticulosis cyst: two inter-related lesions? There are some unusual esophageal lesions, which by their rarity, and location or etiology raise difficult therapeutic decisions for surgeons. In this report, we describe an esophageal inflammatory pseudotumor (IPT) associated with a pseudodiverticulosis cyst in an adult male. We discuss the pathogenic and the anatomopathological aspects of these uncommon associated lesions as well as the treatment of ITP. ( info) |
4/167. Atypical esophageal diverticula associated with progressive systemic sclerosis. Five cases of unusual esophageal diverticula associated with progressive systemic sclerosis (scleroderma) or collagen vascular disease are presented. These wide-mouthed saccular diverticula were infrequently seen in a group of PSS patients with the typical motility disturbance of esophageal involvement and are reminiscent of the diverticula of the colon involved by PSS. ( info) |
5/167. Epiphrenic diverticulum composed of airway components attributed to a bronchopulmonary-foregut malformation: report of a case. Bronchopulmonary-foregut malformation (BPFM), defined originally as pulmonary sequestration with or without communication to the esophagus, has been acknowledged to include congenital foregut diverticula. We present herein the case of a 43-year-old woman with a 9-year history of dysphagia, in whom a barium meal examination demonstrated a 2.5-cm epiphrenic diverticulum and several fistulae. A laparotomy was performed and the lower esophagus without communication to the lung was pulled down and resected, followed by an esophagogastrostomy carried out with fundopexy. Since her operation, the patient has been free of symptoms. Histologically, the diverticulum was observed to be lined by stratified squamous cells, but its shape was formed by mural cartilage, smooth muscle cells, and three ciliated-cell cysts. The dysphagia was considered to have been derived from the kinked esophagus created by the rigid diverticulum, being the possible developmental arrest of a supernumerary lung bud. These findings indicate that this case may involve BPFM in the broad sense. Although several cases of bronchogenic cysts located beneath or across the diaphragm have been reported as a subgroup of BPFM, congenital epiphrenic diverticula has rarely been described. ( info) |
6/167. Esophageal intramural pseudodiverticulosis associated with a web in a 12-year-old boy. Esophageal intramural pseudodiverticulosis (EIPD) is a rare benign disorder characterized by dilation of the submucosal glands. Its etiology and pathogenesis are largely unknown. So far, less than 10 pediatric cases of EIPD have been reported. The authors present the case of a 12-year-old boy with EIPD that was associated with a cervical esophageal web. He was treated successfully with dilation therapy. ( info) |
7/167. Dysphagia in oesophageal intramural pseudo-diverticulosis: fibrosis, dysmotility or web? We describe two cases of oesophageal intramural pseudo-diverticulosis associated with a cervical oesophageal web presenting as intermittent dysphagia. In both cases, disruption of the web endoscopically resulted in lasting relief from symptoms. This observation, together with a review of the literature written during the past 39 years, suggests that oesophageal web formation may be under-reported in this condition and may be more important than either dysmotility or submucosal fibrosis and stricturing in the aetiology of the dysphagia seen in these patients. All patients with a radiological diagnosis of oesophageal intramural pseudo-diverticulosis should have an endoscopic examination which may be both diagnostic and potentially therapeutic. ( info) |
| Esophagopleural fistula (EPF) is a very rare and fatal disease. A 56 year-old man developed a pyothorax resulting from an EPF with esophageal diverticulum after a right pneumonectomy. The patient was successfully treated with a three-stage operation and control of infection and nutritional status. First, fenestration was performed, then an ante-thoracic gastroplasty, and a radical thoracoplasty was performed. Surgical management, nutritional support, and control of infection were the cornerstones of the treatment of EPF. ( info) |
| The incidence of esophageal adenocarcinoma has been increasing compared with squamous cell carcinoma. The most common location of adenocarcinoma of the esophagus is the distal one third. Cancer developing in an esophageal diverticulum is uncommon, but tumors of squamous cell origin in esophageal diverticula have been reported previously. We describe an adenocarcinoma in a midesophageal diverticulum and review malignancies occurring in esophageal diverticula. ( info) |
10/167. Esophagobronchial fistula after thoracoscopic resection of an epiphrenic diverticulum. We report a case of a 54-year-old man presenting with recurrent epiphrenic diverticulum and esophagobronchial fistula 3 years after thoracoscopic diverticulectomy. Surgical correction required transhiatal stapling of the pouch combined with distal esophageal myotomy and Dor fundoplication. ( info) |