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Laparoscopic-thoracoscopic esophageal resection in the treatment of giant epiphrenic esophageal diverticulum (Ivor Lewis operation): Case report.
Int J Surg Case Rep 2018; 52:89-94IJ

Abstract

INTRODUCTION

Complicated esophageal diverticulum is an extremely rare disease. The most widespread surgical tactic in such cases is drainage of the mediastinum and the position of a feeding gastrostomy or enterostomy. Our objective was to demonstrate the possibility of performing a one-step operation in case of giant esophageal diverticulum with necrotic diverticulitis and sepsis on the background of dilatation of the esophagus.

PRESENTATION OF CASE

A 57-year-old woman complained of persistent nagging epigastric pain, heartburn, belching, daily vomiting of eaten food and liquid, impaired swallowing, fever up to 39° C. EGD revealed large pouch of the right esophageal wall in middle and lower third of the esophagus with signs of inflammation, ulceration and necrosis and retained food in the pouch. Barium esophagogram demonstrated 50 × 100 mm epiphrenic diverticulum on the right side and in the lower third of the esophagus which contained food. CBC revealed leukocytosis along with "left upper shift" and ESR.

DISCUSSION

The laparoscopic-thoracoscopic esophageal resection with gastric tube plasty (Ivor Lewis operation) might be the method of choice in cases of giant epiphrenic esophageal diverticula, when esophageal resection is connected with the high risk of anastomotic dehiscence due to esophageal wall necrosis.

CONCLUSION

We have established that in case of necrobiotic changes in the esophageal wall in the area of the diverticulum, this tactic is completely justified because of the greater patient safety and the less risk of the stapler suture line dehiscence.

Authors+Show Affiliations

NGHCI Railway Clinical Hospital at the "Rostov-Glavnyy" Station, OAO Russian Railways, Varfolomeeva Street 92, Rostov-on-Don, Russian Federation(1); FSBEI HE Rostov State Medical University of the Ministry of Health of the Russian Federation, Nakhichevansky Lane 19, Rostov-on-Don, Russian Federation(2).FSBEI HE Rostov State Medical University of the Ministry of Health of the Russian Federation, Nakhichevansky Lane 19, Rostov-on-Don, Russian Federation(2). Electronic address: A_anastacia@icloud.com.FSBEI HE Rostov State Medical University of the Ministry of Health of the Russian Federation, Nakhichevansky Lane 19, Rostov-on-Don, Russian Federation(2).NGHCI Railway Clinical Hospital at the "Rostov-Glavnyy" Station, OAO Russian Railways, Varfolomeeva Street 92, Rostov-on-Don, Russian Federation(1).NGHCI Railway Clinical Hospital at the "Rostov-Glavnyy" Station, OAO Russian Railways, Varfolomeeva Street 92, Rostov-on-Don, Russian Federation(1).NGHCI Railway Clinical Hospital at the "Rostov-Glavnyy" Station, OAO Russian Railways, Varfolomeeva Street 92, Rostov-on-Don, Russian Federation(1); FSBEI HE Rostov State Medical University of the Ministry of Health of the Russian Federation, Nakhichevansky Lane 19, Rostov-on-Don, Russian Federation(2).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30336387

Citation

Khitaryan, Аlexander, et al. "Laparoscopic-thoracoscopic Esophageal Resection in the Treatment of Giant Epiphrenic Esophageal Diverticulum (Ivor Lewis Operation): Case Report." International Journal of Surgery Case Reports, vol. 52, 2018, pp. 89-94.
Khitaryan А, Golovina A, Mezhunts A, et al. Laparoscopic-thoracoscopic esophageal resection in the treatment of giant epiphrenic esophageal diverticulum (Ivor Lewis operation): Case report. Int J Surg Case Rep. 2018;52:89-94.
Khitaryan, А., Golovina, A., Mezhunts, A., Veliev, K., Zavgorodnyaya, R., & Orekhov, А. (2018). Laparoscopic-thoracoscopic esophageal resection in the treatment of giant epiphrenic esophageal diverticulum (Ivor Lewis operation): Case report. International Journal of Surgery Case Reports, 52, pp. 89-94. doi:10.1016/j.ijscr.2018.10.005.
Khitaryan А, et al. Laparoscopic-thoracoscopic Esophageal Resection in the Treatment of Giant Epiphrenic Esophageal Diverticulum (Ivor Lewis Operation): Case Report. Int J Surg Case Rep. 2018;52:89-94. PubMed PMID: 30336387.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic-thoracoscopic esophageal resection in the treatment of giant epiphrenic esophageal diverticulum (Ivor Lewis operation): Case report. AU - Khitaryan,Аlexander, AU - Golovina,Anastasiya, AU - Mezhunts,Arut, AU - Veliev,Kamil, AU - Zavgorodnyaya,Raisa, AU - Orekhov,Аlexey, Y1 - 2018/10/08/ PY - 2018/09/04/received PY - 2018/10/03/accepted PY - 2018/10/20/pubmed PY - 2018/10/20/medline PY - 2018/10/19/entrez KW - Case report KW - Epiphrenic diverticulum KW - Esophageal diverticulum KW - Laparoscopic esophageal surgery KW - Laparoscopic-thoracoscopic esophageal surgery KW - Necrotic diverticulitis SP - 89 EP - 94 JF - International journal of surgery case reports JO - Int J Surg Case Rep VL - 52 N2 - INTRODUCTION: Complicated esophageal diverticulum is an extremely rare disease. The most widespread surgical tactic in such cases is drainage of the mediastinum and the position of a feeding gastrostomy or enterostomy. Our objective was to demonstrate the possibility of performing a one-step operation in case of giant esophageal diverticulum with necrotic diverticulitis and sepsis on the background of dilatation of the esophagus. PRESENTATION OF CASE: A 57-year-old woman complained of persistent nagging epigastric pain, heartburn, belching, daily vomiting of eaten food and liquid, impaired swallowing, fever up to 39° C. EGD revealed large pouch of the right esophageal wall in middle and lower third of the esophagus with signs of inflammation, ulceration and necrosis and retained food in the pouch. Barium esophagogram demonstrated 50 × 100 mm epiphrenic diverticulum on the right side and in the lower third of the esophagus which contained food. CBC revealed leukocytosis along with "left upper shift" and ESR. DISCUSSION: The laparoscopic-thoracoscopic esophageal resection with gastric tube plasty (Ivor Lewis operation) might be the method of choice in cases of giant epiphrenic esophageal diverticula, when esophageal resection is connected with the high risk of anastomotic dehiscence due to esophageal wall necrosis. CONCLUSION: We have established that in case of necrobiotic changes in the esophageal wall in the area of the diverticulum, this tactic is completely justified because of the greater patient safety and the less risk of the stapler suture line dehiscence. SN - 2210-2612 UR - https://www.unboundmedicine.com/medline/citation/30336387/Laparoscopic_thoracoscopic_esophageal_resection_in_the_treatment_of_giant_epiphrenic_esophageal_diverticulum__Ivor_Lewis_operation_:_Case_report_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2210-2612(18)30425-5 DB - PRIME DP - Unbound Medicine ER -