Epiphrenic Diverticulum

Increasingly severe dysphagia had bothered a 77-year-old woman for several months. By the time she sought medical attention, both food and liquids were sticking in the lower esophagus, leading to vomiting and weight loss.

A barium swallow examination showed filling defects in the lower half of the esophagus that suggested esophageal cancer. Endoscopic examination under conscious sedation revealed large amounts of food debris that nearly obstructed the lower esophageal lumen. The patient required 2 more endoscopic examinations, in which large forceps and a snare were used to dislodge the food from the lumen. Another barium swallow (shown) revealed a large epiphrenic diverticulum. An esophageal motility test showed a hypertensive lower esophageal sphincter but was otherwise normal.

A month later, the epiphrenic diverticulum was removed through a left thoracotomy approach, and an esophagomyotomy was performed.

Epiphrenic diverticula are usually asymptomatic. Occasionally, they are associated with a motility disorder, as in this patient. Since the surgery, she has been able to swallow without difficulty.

References:

FOR MORE INFORMATION:

• Debas HT, Payne WS, Cameron AJ, Carlson HC. Physiopathology of lower esophageal diverticulum and itsimplications for treatment.

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• Habein HC Jr, Moersch HJ, Kirklin JW. Diverticula of the lower part of the esophagus; a clinical study of onehundred forty-nine nonsurgical cases.

AMA Arch Intern Med.

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• Varghese TK Jr, Marshall B, Chang AC, et al. Surgical treatment of epiphrenic diverticula: a 30-year experience.

Ann Thorac Surg.

2007;84:1801-1809.