Cases reported "Diverticulum, Esophageal"

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1/24. 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.
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ranking = 1
keywords = operative
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2/24. Esophageal intramural pseudodiverticulosis associated with esophageal perforation.

    We report a rare case of esophageal intramural pseudodiverticulosis with lower esophageal stricture which perforated into the peritoneal cavity after the patient vomited. A 61-year-old man was admitted with severe chest and epigastric pain after dysphagia and vomiting. Under a diagnosis of upper gastrointestinal perforation, laparotomy was performed. The anterior wall of the abdominal esophagus was found to have ruptured, and proximal gastrectomy with abdominal esophagectomy was performed. Histological examination revealed esophageal intramural pseudodiverticulosis with esophageal stricture distal to the site of rupture, and postoperative endoscopy showed diffuse pseudodiverticulosis in the remaining esophagus. The patient is free of symptoms 5 years after the surgery. This case suggests that careful treatment may be indicated in patients with esophageal intramural pseudodiverticulosis with stricture and elevated intraluminal pressure, to minimize the possibility of severe complications such as esophageal perforation.
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ranking = 1
keywords = operative
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3/24. Laparoscopic approach for esophageal achalasia with epiphrenic diverticulum.

    We report the case of a 65-year-old woman with a 10-year history of dysphagia, regurgitation, cough, and 10-kg weight loss caused by an epiphrenic diverticulum associated with esophageal achalasia managed with a laparoscopic approach. A preoperative barium swallow showed a dilated sigmoid esophagus with a 6-cm epiphrenic diverticulum. Esophageal manometry confirmed the absence of peristalsis in the esophageal body. We performed a laparoscopic diverticulectomy and a 7-cm distal esophageal myotomy with a Dor fundoplication. The postoperative course was uneventful. On the third postoperative day a barium swallow showed no leak, and the patient started oral intake. She was discharged home 5 days after the operation free of symptoms and tolerating a soft diet. Sixteen months after surgery, she was asymptomatic and had gained 8 kg. A barium swallow showed a normal-size esophagus with regular emptying. We reaffirm the feasibility, safety, and efficacy of the laparoscopic diverticulectomy and distal myotomy with Dor fundoplication to manage epiphrenic diverticula resulting from esophageal achalasia.
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ranking = 3
keywords = operative
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4/24. Video-assisted resection of pulsative midesophagus diverticula.

    BACKGROUND: Pulsative diverticula located in the midesophagus occur rarely. Surgical treatment is indicated for symptomatic diverticula. This study evaluated a new minimally invasive method of treatment. methods: Three women, ages 69 to 73 years, underwent resections of diverticula via a thoracoscopic access. No major complications were observed. Preoperative symptoms such as dysphagia, regurgitation, aspiration, loss of weight, and retrosternal pain were not reported at follow-up assessment 3 to 60 months after surgery. The patients were highly satisfied with the functional results. CONCLUSIONS: According to our results, minimally invasive treatment of midesophagus diverticula by thoracoscopic resections may be performed with excellent outcome.
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ranking = 1
keywords = operative
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5/24. Esophageal intramural pseudodiverticulosis with mallory-weiss syndrome: report of a case.

    A 62-year-old man with a chief complaint of coughing up blood was revealed to have mallory-weiss syndrome with arterial bleeding by gastrointestinal endoscopy at the esophagogastric junction, and two teardrop-shaped fissures were found longitudinally extending into the muscle layer. Endoscopic treatment with ethanol injection and the administration of a thrombin solution spray failed to control the arterial bleeding. hemostasis was finally archived by suturing the fissures under an open laparotomy. A postoperative barium esophagogram showed multiple flask-shaped outpouchings in the thoracic esophagus, and a diagnosis of esophageal intramural pseudodiverticulosis (EIPD) was thus made. EIPD is usually accompained with esophageal strictures but esophageal bleeding is rare.
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ranking = 1
keywords = operative
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6/24. Laparoscopic resection of an esophageal epiphrenic diverticulum.

    Epiphrenic diverticulum of the esophagus is an uncommon disease. In the light of the benefits of minimally invasive treatment of such a functional disorder, we used the laparoscopic approach for resection of an epiphrenic diverticulum. We found that laparoscopic repair of symptomatic esophageal epiphrenic diverticula is a safe and effective technique with minimal postoperative pain and morbidity. It should be considered as an alternative to the traditional transthoracic approach, and may become the standard technique.
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ranking = 1
keywords = operative
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7/24. Laparoscopic Heller myotomy with epiphrenic diverticulectomy.

    BACKGROUND AND OBJECTIVES: To describe the technique and results of laparoscopic Heller myotomy and Toupet fundoplication combined with epiphrenic diverticulectomy. CASE REPORT: A 75-year-old man presented to our institution complaining of dysphagia to solid foods and liquids. The preoperative preparation included a barium swallow, esophagoscopy, and esophageal manometry. Three months earlier, the patient had a botulinum toxin injection, which provided temporary relief. Ten months later, the patient underwent a laparoscopic Heller myotomy and Toupet fundoplication combined with an epiphrenic diverticulectomy. RESULTS: No complications occurred. The patient tolerated clear liquids on postoperative day 1; on postoperative day 2, he was discharged tolerating full liquids. He returned to full activity in 1 week. CONCLUSIONS: Epiphrenic diverticulectomy combined with treatment for the underlying motor disorder and gastroesophageal reflux prevention is an accepted practice. We demonstrate that this rare problem can be approached with the laparoscopic technique. Given this favorable result, we plan to continue this technique and establish a longer follow-up and wider series.
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ranking = 3
keywords = operative
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8/24. Epiphrenic diverticulum with abnormal manometry: a case report.

    A 50-year-old man was admitted to our hospital with the chief complaints of vomiting and nocturnal cough for one year. His complaints were progressive and had worsened within the last two months. Chest X-ray revealed a right-sided paracardiac opacity. Computed tomography of the thorax showed a supradiaphragmatic mass lesion containing air and solid components. barium esophagogram revealed a giant distal esophageal diverticulum and hiatal hernia. Stationary manometric examination of the esophagus showed non-specific esophageal motility disorder. The patient underwent a successful abdominal approach diverticulectomy operation and the postoperative course was uncomplicated. There is a high prevalence of esophageal motility abnormalities in patients with epiphrenic diverticula, though they are very rare, and, as in this case, may be difficult to classify.
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ranking = 1
keywords = operative
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9/24. The KTP laser: an emerging tool in pediatric otolaryngology.

    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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ranking = 2
keywords = operative
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10/24. Pharyngoesophageal diverticulum complicated by squamous cell carcinoma.

    Pharyngoesophageal (Zenker's) diverticulum is a relatively common acquired condition that may cause dysphagia and regurgitation of food. Squamous carcinoma may develop in such a diverticulum, but this complication is exceedingly rare and may not be suspected preoperatively. This report describes a case in which the diagnosis of squamous carcinoma was made after regurgitation of malignant tissue from a radiographically proven pharyngoesophageal diverticulum. The patient was treated by simple diverticulectomy and postoperative radiation therapy.
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ranking = 2
keywords = operative
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