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Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report.
Surg Case Rep 2017; 3(1):63SC

Abstract

BACKGROUND

Epiphrenic esophageal diverticulum is a rare condition that is often associated with a concomitant esophageal motor disorder. Some patients have the chief complaints of swallowing difficulty and gastroesophageal reflux; traditionally, such diverticula have been resected via right thoracotomy. Here, we describe a case with huge multiple epiphrenic diverticula with motility disorder, which were successfully resected using a video-assisted thoracic and laparoscopic procedure.

CASE PRESENTATION

A 63-year-old man was admitted due to dysphagia, heartburn, and vomiting. An esophagogram demonstrated an S-shaped lower esophagus with multiple epiphrenic diverticula (75 × 55 mm and 30 × 30 mm) and obstruction by the lower esophageal sphincter (LES). Esophageal manometry showed normal peristaltic contractions in the esophageal body, whereas the LES pressure was high (98.6 mmHg). The pressure vector volume of LES was 23,972 mmHg2 cm. Based on these findings, we diagnosed huge multiple epiphrenic diverticula with a hypertensive lower esophageal sphincter and judged that resection might be required. We performed lower esophagectomy with gastric conduit reconstruction using a video-assisted thoracic and hand-assisted laparoscopic procedure. The postoperative course was uneventful, and the esophagogram demonstrated good passage, with no leakage, stenosis, or diverticula.

CONCLUSIONS

The most common causes of mid-esophageal and epiphrenic diverticula are motility disorders of the esophageal body; appropriate treatment should be considered based on the morphological and motility findings.

Authors+Show Affiliations

Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. ttakahashi2@gesurg.med.osaka-u.ac.jp.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28485002

Citation

Taniguchi, Yoshiki, et al. "Multiple Huge Epiphrenic Esophageal Diverticula With Motility Disease Treated With Video-assisted Thoracoscopic and Hand-assisted Laparoscopic Esophagectomy: a Case Report." Surgical Case Reports, vol. 3, no. 1, 2017, p. 63.
Taniguchi Y, Takahashi T, Nakajima K, et al. Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report. Surg Case Rep. 2017;3(1):63.
Taniguchi, Y., Takahashi, T., Nakajima, K., Higashi, S., Tanaka, K., Miyazaki, Y., ... Doki, Y. (2017). Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report. Surgical Case Reports, 3(1), p. 63. doi:10.1186/s40792-017-0339-6.
Taniguchi Y, et al. Multiple Huge Epiphrenic Esophageal Diverticula With Motility Disease Treated With Video-assisted Thoracoscopic and Hand-assisted Laparoscopic Esophagectomy: a Case Report. Surg Case Rep. 2017;3(1):63. PubMed PMID: 28485002.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report. AU - Taniguchi,Yoshiki, AU - Takahashi,Tsuyoshi, AU - Nakajima,Kiyokazu, AU - Higashi,Shigeyoshi, AU - Tanaka,Koji, AU - Miyazaki,Yasuhiro, AU - Makino,Tomoki, AU - Kurokawa,Yukinori, AU - Yamasaki,Makoto, AU - Takiguchi,Shuji, AU - Mori,Masaki, AU - Doki,Yuichiro, Y1 - 2017/05/08/ PY - 2017/02/13/received PY - 2017/05/01/accepted PY - 2017/5/10/entrez PY - 2017/5/10/pubmed PY - 2017/5/10/medline KW - Epiphrenic esophageal diverticulum KW - Esophageal motility KW - Hypertensive lower esophageal sphincter KW - Video-assisted thoracic surgery SP - 63 EP - 63 JF - Surgical case reports JO - Surg Case Rep VL - 3 IS - 1 N2 - BACKGROUND: Epiphrenic esophageal diverticulum is a rare condition that is often associated with a concomitant esophageal motor disorder. Some patients have the chief complaints of swallowing difficulty and gastroesophageal reflux; traditionally, such diverticula have been resected via right thoracotomy. Here, we describe a case with huge multiple epiphrenic diverticula with motility disorder, which were successfully resected using a video-assisted thoracic and laparoscopic procedure. CASE PRESENTATION: A 63-year-old man was admitted due to dysphagia, heartburn, and vomiting. An esophagogram demonstrated an S-shaped lower esophagus with multiple epiphrenic diverticula (75 × 55 mm and 30 × 30 mm) and obstruction by the lower esophageal sphincter (LES). Esophageal manometry showed normal peristaltic contractions in the esophageal body, whereas the LES pressure was high (98.6 mmHg). The pressure vector volume of LES was 23,972 mmHg2 cm. Based on these findings, we diagnosed huge multiple epiphrenic diverticula with a hypertensive lower esophageal sphincter and judged that resection might be required. We performed lower esophagectomy with gastric conduit reconstruction using a video-assisted thoracic and hand-assisted laparoscopic procedure. The postoperative course was uneventful, and the esophagogram demonstrated good passage, with no leakage, stenosis, or diverticula. CONCLUSIONS: The most common causes of mid-esophageal and epiphrenic diverticula are motility disorders of the esophageal body; appropriate treatment should be considered based on the morphological and motility findings. SN - 2198-7793 UR - https://www.unboundmedicine.com/medline/citation/28485002/Multiple_huge_epiphrenic_esophageal_diverticula_with_motility_disease_treated_with_video_assisted_thoracoscopic_and_hand_assisted_laparoscopic_esophagectomy:_a_case_report_ L2 - https://dx.doi.org/10.1186/s40792-017-0339-6 DB - PRIME DP - Unbound Medicine ER -