Diverticula of the Thoracic Portion of the Esophagus: Report of Forty-Two Cases

Abstract

Although the Zenker type of diverticulum is often considered to arise primarily in the esophagus, it is more correct to associate it with the lower portion of the pharynx. As a compromise it is sometimes described as a pharyngoesophageal diverticulum. Because of the fact that this type of diverticulum almost always produces difficulty in swallowing, it is recognized during life much more commonly than diverticula that are of true esophageal origin.Esophageal diverticula are of much commoner occurrence than diverticula which arise from the pharynx, but because esophageal diverticula are usually of the so-called traction type, the apex of the sacculation points upward and rarely becomes of sufficient size to produce any symptoms referable to the esophagus. When these diverticula are found, it is almost always incidentally, at necropsy. Occasionally infection of the sac may occur, with perforation into a bronchus or into the mediastinum, resulting in the formation of an esophagobronchial fistula or mediastinal abscess. A few diverticula of the thoracic portion of the esophagus have attained sufficient size to produce considerable distress. These have been recognized easily on roentgenoscopic examination. Also, smaller diverticula, which did not produce esophageal symptoms have been rec¬ ognized when roentgenoscopic examination has been carried out as part of the routine examination.In a review of diverticula of the thoracic portion of the esophagus, Heacock l found that 85 cases previously had been reported. To this series he added 2 cases that had come under his observation. In 1 of these there were multiple sacculations and the patient had experi¬ enced difficulty in swallowing. In the other case the sac was single and

Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum

“…Heartburn arises from either prolonged exposure to physiologic reflux due to impaired esophageal motility or from acid produced by fermentation of material retained in the diverticulum. It was not until 1934 that Vinson [15] recognized that most distal esophageal diverticula are associated with esophageal motility disorders such as achalasia, diffuse esophageal spasm, or hypertensive lower esophageal sphincter. The etiology remains unclear.…”

Carcinoma of the esophagus developing at the site of lye stricture

“…11 Carcinoma has sometimes been noted within aberrant structures such as diverticula. ', 10, z43 :{gv 39 Cardiospasm or achalasia is occasionally associated with the late appearance ot carcinoma of the esophagus, but frequently the neo-plasm originates in the dilated pouch above the constricted portion of esophagus rather than within the constricted region.2, 4, 6 , 1% 21, 25, 31, 3% 41 T h e development of malignant neoplasms above the stricture, then, cannot be considered strictly analogous to those that develop in the zone of scarring.…”

New Look at Epiphrenic Diverticula

“…The lower esophageal sphincter pressure (LESP) in two of these patients was normal before and after the diverticula developed. The epiphrenic diverticula in six patients were observed for 19, 10,8,5,5, and 4 years, respectively, without increasing in size (Fig. 2).…”