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A thoracoscopically resected case of the diverticulum in the middle esophagus.
Surg Case Rep 2019; 5(1):109SC

Abstract

BACKGROUND

Approximately 65% of esophageal diverticulum cases are asymptomatic and are found by endoscopic examination. Symptomatic middle esophageal diverticulum requiring surgery is rare. In recent years, endoscopic surgery for middle esophageal diverticulum has been reported, but cases remain few in number, and the surgical indication, surgical procedure, and postoperative results are unknown.

CASE PRESENTATION

A 41-year-old man had been diagnosed as having a middle esophageal diverticulum based on an upper gastrointestinal contrast examination performed when he was 30 years old. He had not received treatment because he was asymptomatic. Eight months earlier, he experienced chest discomfort after eating and visited our hospital. The diameter of his middle esophageal diverticulum was 47 mm. A gastrointestinal endoscopy revealed a diverticulum in the right wall located 30 cm from the incisor row. The pathological findings of the endoscopic biopsy were atypical epithelium and no malignant findings. We confirmed the function of the lower esophageal sphincter, and the esophageal body peristaltic wave was observed to be normal using high-resolution manometry. We decided to perform a thoracoscopic diverticulectomy based on his symptoms and the possibility of malignancy suggested by the atypical epithelium. Surgery was performed with the patient in a prone position via 4 ports, and intraoperative endoscopy was performed during the surgery. To achieve a complete resection of the diverticulum, threads were placed on the oral and anal sides of the diverticulum, the threads were pulled, and the diverticulum was resected using an automatic suturing device. A postoperative upper gastrointestinal contrast examination revealed no abnormalities. He was discharged on postoperative day 12.

CONCLUSIONS

During thoracoscopic surgery for middle esophageal diverticulum, we think that pulling and separating the diverticulum and confirming the lumen using endoscopy are useful for reducing the risk of postoperative recurrence and stenosis. Few reports of long-term performance after surgery have been made for this procedure. Therefore, we believe that long-term follow-up is necessary.

Authors+Show Affiliations

Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. sozawa@tokai.ac.jp.Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31289952

Citation

Yatabe, Kentaro, et al. "A Thoracoscopically Resected Case of the Diverticulum in the Middle Esophagus." Surgical Case Reports, vol. 5, no. 1, 2019, p. 109.
Yatabe K, Oguma J, Ozawa S, et al. A thoracoscopically resected case of the diverticulum in the middle esophagus. Surg Case Rep. 2019;5(1):109.
Yatabe, K., Oguma, J., Ozawa, S., Koyanagi, K., Kazuno, A., Yamamoto, M., & Ninomiya, Y. (2019). A thoracoscopically resected case of the diverticulum in the middle esophagus. Surgical Case Reports, 5(1), p. 109. doi:10.1186/s40792-019-0668-8.
Yatabe K, et al. A Thoracoscopically Resected Case of the Diverticulum in the Middle Esophagus. Surg Case Rep. 2019 Jul 9;5(1):109. PubMed PMID: 31289952.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A thoracoscopically resected case of the diverticulum in the middle esophagus. AU - Yatabe,Kentaro, AU - Oguma,Junya, AU - Ozawa,Soji, AU - Koyanagi,Kazuo, AU - Kazuno,Akihito, AU - Yamamoto,Miho, AU - Ninomiya,Yamato, Y1 - 2019/07/09/ PY - 2019/04/04/received PY - 2019/07/02/accepted PY - 2019/7/11/entrez PY - 2019/7/11/pubmed PY - 2019/7/11/medline KW - Diverticulum in the middle esophagus KW - Thoracoscopic surgery KW - True diverticulum SP - 109 EP - 109 JF - Surgical case reports JO - Surg Case Rep VL - 5 IS - 1 N2 - BACKGROUND: Approximately 65% of esophageal diverticulum cases are asymptomatic and are found by endoscopic examination. Symptomatic middle esophageal diverticulum requiring surgery is rare. In recent years, endoscopic surgery for middle esophageal diverticulum has been reported, but cases remain few in number, and the surgical indication, surgical procedure, and postoperative results are unknown. CASE PRESENTATION: A 41-year-old man had been diagnosed as having a middle esophageal diverticulum based on an upper gastrointestinal contrast examination performed when he was 30 years old. He had not received treatment because he was asymptomatic. Eight months earlier, he experienced chest discomfort after eating and visited our hospital. The diameter of his middle esophageal diverticulum was 47 mm. A gastrointestinal endoscopy revealed a diverticulum in the right wall located 30 cm from the incisor row. The pathological findings of the endoscopic biopsy were atypical epithelium and no malignant findings. We confirmed the function of the lower esophageal sphincter, and the esophageal body peristaltic wave was observed to be normal using high-resolution manometry. We decided to perform a thoracoscopic diverticulectomy based on his symptoms and the possibility of malignancy suggested by the atypical epithelium. Surgery was performed with the patient in a prone position via 4 ports, and intraoperative endoscopy was performed during the surgery. To achieve a complete resection of the diverticulum, threads were placed on the oral and anal sides of the diverticulum, the threads were pulled, and the diverticulum was resected using an automatic suturing device. A postoperative upper gastrointestinal contrast examination revealed no abnormalities. He was discharged on postoperative day 12. CONCLUSIONS: During thoracoscopic surgery for middle esophageal diverticulum, we think that pulling and separating the diverticulum and confirming the lumen using endoscopy are useful for reducing the risk of postoperative recurrence and stenosis. Few reports of long-term performance after surgery have been made for this procedure. Therefore, we believe that long-term follow-up is necessary. SN - 2198-7793 UR - https://www.unboundmedicine.com/medline/citation/31289952/A_thoracoscopically_resected_case_of_the_diverticulum_in_the_middle_esophagus L2 - https://dx.doi.org/10.1186/s40792-019-0668-8 DB - PRIME DP - Unbound Medicine ER -