Intramural esophageal pseudodiverticulosis

Abstract

Abstract. The authors describe their experience with five cases of intramural esophageal pseudodiverticulosis. All cases presented with dysphagia and were shown to have another underlying abnormality either in the esophagus or stomach. The symptoms subsided with appropriate therapy, but the pseudodiverticula persisted. Key words:Intramural esophageal pseudodiverticulosis -Esophagram -Dysphagia. Case 2A 74-year-old male diabetic presented with a 5-year history of mild dysphagia when drinking warm fluids. He is on no medication. An esophagram ( Fig. 2A) demonstrated multiple pseudodiverticula extending along the course of the entire esophagus. Endoscopy revealed multiple plaques that bled easily on scraping. Smears and culture of the plaque material confirmed a diagnosis of moniliasis. He became symptom free after a course of medical therapy for the moniliasis. A follow-up esophagram 4 years later (Fig. 2B) demonstrated persistent pseudodiverticulosis and hiatal hernia with lower esophageal stricture. He remains symptom free.Esophageal intramural pseudodiverticulosis is a rare entity first described in 1960 [1]. Fewer than 100 cases have been reported [1][2][3][4][5]. We report on our experience with five cases with this entity, all presenting with a history of dysphagia of several months to several years duration. All cases had either esophageal stricture, hiatus hernia with reflux, or monilial esophagitis. After appropriate therapy, symptoms generally subsided, but the pseudodiverticulosis persisted. Case Reports Case 1A 36-year-old female first presented 5 years ago complaining of pain on swallowing. An esophagram was normal, except for a hiatus hernia with free gastroesophageal reflux. Endoscopy was normal. She had intermittent symptoms, and a repeat esophagram 5 years later (Fig. 1) Case 3A 77-year-old male with known pulmonary oat cell carcinoma receiving systemic chemotherapy complained of difficulty in swallowing. He had oral thrush. The esophagram (Fig. 3) demonstrated multiple pseudodiverticula within the mid and lower esophagus. The patient's dysphagia improved after therapy for the monilia. He died 2 months later. Neither an esophagram nor postmortem examination was obtained. Case 4A 72-year-old male with a past history of vagotomy and subtotal gastrectomy for peptic ulcer disease complained of difficulty in swallowing. An esophagram demonstrated a lower esophageal mass. This mass was shown to be an adenocarcinoma of the esophagus and a partial esophagectomy was performed. He was lost to follow-up for 10 years, at which time he presented with complaints of difficulty in swallowing. The esophagram (Fig. 4A) showed a stricture at the esophagogastric anastamosis with multiple pseudodiverticula. The stricture was dilated with improvement of his symptoms. A follow-up esophagram 1 year later (Fig. 4 B) revealed an increase in the number of pseudodiverticula with bridging. He is essentially symptom free. Case 5A 44-year-old female presented with vague abdominal pain but no dysphagia. An ultrasound examination...