Traction esophageal diverticulum: a rare cause of gastro-intestinal bleeding

Abstract

Esophageal diverticula are uncommon lesions that are usually classified according to their location (cervical, thoracic, or epiphrenic), or underlying pathogenesis (pulsion or traction), and their morphology (true or false).The majority of esophageal diverticula are acquired lesions that occur predominantly in elderly adults. Pulsion, or false, diverticula are the most commonly encountered type of esophageal diverticula noticed at the level of cricopharyngeus muscle, occur as a localized outpouchings that lacks a muscular coat, and as such their wall is formed entirely by mucosa and submucosa.True, or traction, esophageal diverticulum (TED) is seen in the middle one third of the thoracic esophagus in a peribronchial location, occurs secondary to mediastinal inflammatory lesions such as tuberculosis or histoplasmosis. The resultant desmoplastic reaction in the paraesophageal tissue causes full thickness pinching on the esophageal wall, producing a conical, broad-mouthed true diverticulum. They often project to the right side because subcarinal lymph nodes in this area are closely associated with the right anterior wall of the esophagus.TED usually presents with symptoms such as dysphagia, postural regurgitation, belching, retrosternal pain, heartburn, and epigastric pain. As in patients with pharyngoesophageal (Zenker’s) diverticula, pulmonary symptoms are often present but underestimated in TED patients. These symptoms range from mild nocturnal cough to life-threatening massive aspiration. In this particular report we describe a rare case of TED presenting as a symptomatic upper gastrointestinal bleeding. Diagnostic evaluation of TED includes chest X-ray, barium esophagogram and manometry. A significant proportion of lower esophageal diverticula are associated with motility disorders. Management of TED include treating the underlying cause sometimes a surgical resection of diverticulum along with esophageal myotomy is necessitated in symptomatic patients.

Multiple oesophago-respiratory fistulae: sequelae of pulmonary tuberculosis in retroviral infection

“…at the carinal level). Most case studies in the literature have reported patients with small and collapsed fistula tracts, (5,9,10) whereas our patient had multiple large and long oesophago-respiratory fistulae.…”

“…Tuberculous lymphadenitis may even adhere to the oesophagus, leading to either full-thickness erosion or traction of the oesophageal wall. (9) The former would lead to an oesophagomediastinal fistula, while the latter would cause an oesophageal traction diverticulum. Apart from this, oesophagitis in retroviral disease may cause ulceration, perforation, fistula formation, haemorrhage and stricture of the oesophagus.…”

Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

“…The first reported case of a traction diverticulum caused by ACSS was the result of an adherence of the hypopharyngeal mucosa to a bone graft in a patient after fusion of a C6 and C7 fracture and dislocation . Since then, 22 cases have been reported in the literature . Presentation has been varied, with some patients presenting a few months after ACSS and some identified as late as 18 years after surgery.…”

“…Presentation has been varied, with some patients presenting a few months after ACSS and some identified as late as 18 years after surgery. Six cases were associated with bone‐grafting techniques during ACSS, and four cases occurred after traumatic injuries . Six cases had associated infection, which resulted in pulmonary and mediastinal complications and death .…”

Divertículo Em Esôfago Proximal Secundário À Sequela De Tuberculose: Um Relato De Caso

“…Quando sintomáticos, o quadro se apresenta com disfagia. Apesar de pouco sintomáticos, podemos esperar algumas complicações, como ruptura espontânea, formação de fístula, predisposição a neoplasias e, raramente, sangramento (6) .Como diagnóstico diferencial, devemos pensar em acalasia, câncer de esôfago, outros distúrbios da motilidade esofagiana ou mesmo o próprio divertículo de Zencker (4) . O diagnóstico é baseado em anamnese e exame físico, associados a exames de imagem, como esofagografiabaritada (1) .…”