An uncommon source of upper gastrointestinal bleeding: epiphrenic esophageal diverticulum

Abstract

Esophageal diverticula are rare findings that have an estimated incidence of 1 per 500 000 people per year, even though acute upper gastrointestinal bleeding is a relatively common medical emergency with an incidence of up to 150 per 100 000 people per year and a mortality rate of 7–14%. An 83-year-old man presented with hematemesis and melena. Urgent upper endoscopy revealed an esophageal diverticulum, within which was an adherent clot. Removal of the clot identified a bleeding vessel within the diverticulum; this was successfully clipped and hemostasis was achieved. To the best of our knowledge, this is the first case report of a bleeding epiphrenic esophageal diverticulum that was successfully managed endoscopically with hemostatic clips alone. While rare, our case serves as a reminder that bleeding epiphrenic esophageal diverticula can present as massive upper gastrointestinal bleeding and urgent endoscopic therapy can be life-saving.

Laparoscopic approach in the treatment of large epiphrenic esophageal diverticulum.

“…Epiphrenic diverticulum is a relatively rare disorder of the lower third of the esophagus, which is defined as mucosa and submucosa herniation through the muscular layers of the esophageal wall [ 1 – 3 ]. Usually it is located at the right side of the esophagus [ 4 , 5 ]. There is an estimated prevalence of 0.015% in the United States, 0.77% in Japan and up to 2% in Europe, but the true incidence is unknown as only 15–20% of patients are symptomatic, while a great number of cases are diagnosed incidentally during radiographic or endoscopic examinations performed for other reasons [ 6 , 7 ].…”

Esophageal Fibroma That Envelops Esophagus and Causes Traction Diverticulum

“…Endoscopy has the advantages of detecting diverticulum, detecting malignancy which may develop on the basis of diverticulum, interfere with bleeding from diverticulum. 7 Esophageal ultrasonography provided more detailed information about the exact loction and nature of the lesion. With these two tests, some informations can be obtained about the locationof the lesion between the wall layers, cystic-solid separation, the relationship between the lesion and paraesophageal tissues and the surrounding lymph nodes.…”

A Case Report on Large Epiphrenic Diverticula

“…A case of long-standing diverticula might lead to stasis and overgrowth of bacteria causing inflammation. Such cases may lead to ulceration and might develop hemorrhage and perforation of the diverticula wall [10]. Besides this food particles also can be entrapped in the diverticula sac and create complications.…”