Esophageal intramural pseudodiverticulosis

Abstract

Esophageal intramural pseudodiverticulosis (EIP) is a rare condition of unknown etiology. It is characterized by multiple, small, flaskshaped outpouchings in the esophageal wall. Involvement may be segmental or diffuse. Since this entity was first reported in 1960, there have been 43 cases described in the English literature. These cases are reviewed and six additional cases are reported with emphasis on clinical and radiographic parameters of this entity.

A Case of Esophageal Intramural Pseudodiverticulosis

“…An esophageal stricture is observed in 76-90% of patients, which are most common in the upper esophagus, followed by the lower esophagus and middle esophagus. 8,12 In our patient, an esophageal stricture was found neither at first nor on the follow up EGD performed six months later. In 25% of patients, the openings of the EIP are found on the endoscopy.…”

“…8 EIP shows bimodal peak incidence in teens 9,10 and in the fifties and sixties. 11,12 Patients who have a coexisting disease such as diabetes mellitus, esophageal candidiasis, reflux esophagitis, chronic alcohol abuse, and corrosive acid injury have a higher risk to develop EIP. 8,13 EIP is often associated with benign esophageal disease, but there are several reports where EIP was associated with esophageal cancer.…”

“…11,12 About 10% of patients require no treatment. 17 If there is concomitant reflux esophagitis or candidiasis, conservative treatment for these diseases sometimes improved both the symptoms and the pseudodiverticulosis.…”

“…16 However, when there is an accompanied esophageal stricture, mechanical endoscopic dilatation leads to clinical treatment response. 11 Cho et al 12 reported that symptoms were markedly improved by dilating the esophageal stricture accompanied by pseudodiverticulosis. Moreover, by dilating the esophageal stricture, pseudodiverticula was reduced or disappeared in some selected cases.…”

Esophagobronchial Fistula Resulting from Esophageal Intramural Pseudodiverticulosis

“…Their distribu tion ranges from localized segments to involvement of the entire esophagus [II], Besides their radiographic appearance, the characteris tic mucosal elevations that represent the ostia of the out pouchings can be detected endoscopicallv. These pin point openings may contain a discharge, or may appear as multiple erythematous orifices protruding from the esophageal lumen [ 14,22,23], The appearance of the esophagel mucosa, however, ranges from normal to mildly hyperemic and edematous [11,21]. Endoscopy is ex tremely helpful in ruling out the presence of a neoplasm as well as in determining the character of the colonizing flora.…”