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Diverticulum of the midthoracic esophagus: pathogenesis and surgical treatment.
Surg Endosc 2002; 16(5):871SE

Abstract

Midthoracic esophageal diverticula represent 15% of all esophageal diverticula. Gastrointestinal endoscopy, barium swallow, esophageal manometry (indispensable for detecting any motor alterations often at the root of the pathogenesis of the diverticulum and for selecting the best surgical option), and 24-h pHmetry are the correct examinations to perform. Simple diverticulectomy performed via thoracoscopy can be sufficient for small diverticula without associated motor alterations. In other cases, it is best to combine diverticulectomy with a longitudinal extramucous myotomy extending at least 3 or 4 cm above and below the neck of the diverticulum or to the entire esophageal body for diffuse esophageal spasm. We report the case of a 67-year-old male patient with a sacciform diverticulum at the mid-third on the anterior wall of the thoracic esophagus. Manometric examination showed peristaltic waves with an amplitude and duration that were above normal at the inferior third of the esophagus. Lower esophageal sphincter (LES) and upper esophageal sphincter (UES) were essentially normal. The diagnosis was pulsion-type midthoracic esophageal diverticulum. We performed a diverticulectomy with endoGIA via right thoracoscopy and extramucous myotomy extended from the upper margin of the diverticulum to the esophageal inlet in the hiatus, corresponding to the area showing motor alteration. After 3 months, the patient reported complete remission of symptoms and had gained 4 kg. Radiography of the digestive tube showed a normal transit at the distal esophagus. Manometric follow-up revealed the presence of peristaltic waves with a normal amplitude and duration along the entire esophagus.

Authors+Show Affiliations

Department of General Surgery, University of Udine, 33100 Udine, Italy. giuseppe.dado@dsc.uniud.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

11997849

Citation

Dado, G, et al. "Diverticulum of the Midthoracic Esophagus: Pathogenesis and Surgical Treatment." Surgical Endoscopy, vol. 16, no. 5, 2002, p. 871.
Dado G, Bresadola V, Terrosu G, et al. Diverticulum of the midthoracic esophagus: pathogenesis and surgical treatment. Surg Endosc. 2002;16(5):871.
Dado, G., Bresadola, V., Terrosu, G., & Bresadola, F. (2002). Diverticulum of the midthoracic esophagus: pathogenesis and surgical treatment. Surgical Endoscopy, 16(5), p. 871.
Dado G, et al. Diverticulum of the Midthoracic Esophagus: Pathogenesis and Surgical Treatment. Surg Endosc. 2002;16(5):871. PubMed PMID: 11997849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diverticulum of the midthoracic esophagus: pathogenesis and surgical treatment. AU - Dado,G, AU - Bresadola,V, AU - Terrosu,G, AU - Bresadola,F, Y1 - 2002/02/28/ PY - 2001/06/28/received PY - 2001/11/26/accepted PY - 2002/5/9/pubmed PY - 2002/5/25/medline PY - 2002/5/9/entrez SP - 871 EP - 871 JF - Surgical endoscopy JO - Surg Endosc VL - 16 IS - 5 N2 - Midthoracic esophageal diverticula represent 15% of all esophageal diverticula. Gastrointestinal endoscopy, barium swallow, esophageal manometry (indispensable for detecting any motor alterations often at the root of the pathogenesis of the diverticulum and for selecting the best surgical option), and 24-h pHmetry are the correct examinations to perform. Simple diverticulectomy performed via thoracoscopy can be sufficient for small diverticula without associated motor alterations. In other cases, it is best to combine diverticulectomy with a longitudinal extramucous myotomy extending at least 3 or 4 cm above and below the neck of the diverticulum or to the entire esophageal body for diffuse esophageal spasm. We report the case of a 67-year-old male patient with a sacciform diverticulum at the mid-third on the anterior wall of the thoracic esophagus. Manometric examination showed peristaltic waves with an amplitude and duration that were above normal at the inferior third of the esophagus. Lower esophageal sphincter (LES) and upper esophageal sphincter (UES) were essentially normal. The diagnosis was pulsion-type midthoracic esophageal diverticulum. We performed a diverticulectomy with endoGIA via right thoracoscopy and extramucous myotomy extended from the upper margin of the diverticulum to the esophageal inlet in the hiatus, corresponding to the area showing motor alteration. After 3 months, the patient reported complete remission of symptoms and had gained 4 kg. Radiography of the digestive tube showed a normal transit at the distal esophagus. Manometric follow-up revealed the presence of peristaltic waves with a normal amplitude and duration along the entire esophagus. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/11997849/Diverticulum_of_the_midthoracic_esophagus:_pathogenesis_and_surgical_treatment_ L2 - https://dx.doi.org/10.1007/s00464-001-4217-7 DB - PRIME DP - Unbound Medicine ER -