medigraphic.com
ISSN 1665-2576 (Print)

2010, Number 1

<< Back Next >>

Rev Mex Cir Endoscop 2010; 11 (1)

Nutcracker esophagus and epiphrenic diverticulum: A case report

Ruiz LJ, Castillo GA, González PI, Barinaga-Rementeria R, Maldonado VA, Cornejo LG, Nájera RI, Cortés RP, Echeverri ND

Language: Spanish
References: 21
Page: 32-35
PDF size: 190.57 Kb.


ABSTRACT

Epiphrenic diverticula represent an uncommon finding in esophageal disease and are usually related to esophageal motility disorders. When the esophageal wall weakens due to abnormal peristalsis, a sac-like evagination is formed. Patients with respiratory symptoms, large diverticula or severe clinical manifestations have indications for surgery. In this paper we present the case of a 61 year old male patient with dysphagia, regurgitation, heartburn and chest pain without any response to medical treatment. An epiphrenic diverticulum was found in the distal portion of the esophagus, and manometric studies were compatible with nutcracker esophagus. Laparoscopic diverticulectomy, cardiomyotomy and fundoplication were performed using endoscopic transoperatory guidance. A discussion of the diagnostic approach to epiphrenic diverticula, with special emphasis in its relationship with esophageal motility disorders, is also included.


REFERENCES

  1. de Angulo DR, Ortiz EMA, Martínez HLF, Munítiz RV, Parrilla PP. Divertículos epifrénicos: ¿Cómo y cuándo operar? CIRESP 2009; 85: 196–204.

  2. Varghese TK, Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula: A 30- year experience. Ann Thorac Surg 2007; 84: 1801–9

  3. Benacci JC, Deschamps C, Trastek VF, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg 1993; 55: 1109–14.

  4. Conrad C, Nissen F. Giant epiphrenic diverticula. Eur J Radiol1982; 2: 48–9.

  5. Parikh HK, Deshpande RK, Desai PB et al. Epiphrenic diverticulum of the esophagus. Indian J Gastroenterol 1991; 10: 150–1.

  6. Lavini C, Morandi U, Salcito D, Smerieri A, Fontana G, Lodi R. Epiphrenic megadiverticula: clinical and therapeutic considerations. Case contributions. Ann Ital Chir 1983; 55: 211–9.

  7. Streitz Jr JM. Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis. Arch Surg 1992; 127: 585–7.

  8. Eubanks TR, Pellegrini CA. Minimally invasive treatment of esophageal diverticula. Semin Thorac Cardiovasc Surg 1999; 11: 363–7.

  9. Debas HT, Payne WS, Cameron AJ, Carlson HC. Physiopathology of lower esophageal diverticulum and its implications for treatment. Surg Gynecol Obstet 1980; 151: 593–600.

  10. Fegiz G, Paolini A, De Marchi C, Tosato F. Surgical management of esophageal diverticula. World J Surg 1984; 8: 757–65.

  11. Hamilton S. Esophageal leiomyoma arising in an epiphrenic diverticulum. Eur J Radiol 1988; 8: 118–9.

  12. Stroh C, Hohmann U, Meyer F, Manger T. Epiphrenic esophageal diverticulum after laparoscopic placement of an adjustable gastric band. Obes Surg 2006; 16: 372–4.

  13. Tutain R, Castell DO. Review article: oesophageal spasm – diagnosis and management. Aliment Pharmacol Ther 2006; 23: 1393-402.

  14. Dalton CB, Castell DO, Richter JE. The changing faces of the nutcracker esophagus. Am J Gastroenterol 1988; 83: 623-8.

  15. Kahrilas PJ. Esophageal motility disorders: current concepts of pathogenesis and treatment. Can J Gastroenterol 2000; 14: 221-31.

  16. Kilic A, Schuchert MJ, Awais O, Luketich JD, Landreneau RJ. Surgical management of epiphrenic diverticula in the minimally invasive era. JSLS 2009; 13: 160–164.

  17. Rosati R, Fumagalli U, Bona S, Zago M, Celotti S, Bisagni P, Peracchia A Laparoscopic treatment of epiphrenic diverticula. J Laparoendosc Adv Surg Tech A 2001; 11: 371–375.

  18. Hiran C. Minimally invasive operation for esophageal diverticula. Ann Thorac Surg 2005; 80: 2076–81.

  19. Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg 2005; 190: 891-4.

  20. Nehra D, Lord RV, DeMeester TR, Theisen J, Peters JH, Crookes PF, Bremner CG. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg 2002; 235: 346-54.

  21. Brian E, Weiser K. Esophageal motility disorders; medical therapy. J Clin Gastroenterol 2008; 42: 652–658.




2020     |     www.medigraphic.com