Chronic Recurrent Esophageal Diverticulitis - A Rare Entity

Abstract

In this report, we seek to shed light on a 44-year-old Caucasian male with a known history of an esophageal diverticulum, who was transferred to our facility after an upper endoscopy at an outside hospital suggested a purulent discharge emanating from the mouth of a mid-esophageal diverticulum. A barium swallow done at the outside institution had reportedly demonstrated an 8 cm long barium collection parallel to and anterolateral to the mid-and distal esophagus which terminated several centimeters proximal to the gastroesophageal junction. At our facility, antibiotics (piperacillin/tazobactam) were continued, and a double-contrast esophagram was performed. The presence of an unusual mid-esophageal diverticulum was confirmed. He clinically improved after a 3-day course of intravenous broad-spectrum antibiotics. No surgical or endoscopic repair was elected as the patient opted for continued medical management. While esophageal diverticula are not rare in humans, to our knowledge, this is the first report of development of esophageal diverticulitis in humans. We believe that antibiotic coverage in addition to dietary restriction is the logical mainstay of acute therapy. Optimal antibiotic coverage should likely include oral flora aerobes and anaerobes. Once symptoms resolve, diverticula may be managed expectantly.

Epiphrenic Diverticulum: 20-Year Single-Institution Experience

“…8,[15][16][17] Routine surgery for all epiphrenic diverticula regardless of symptoms is no longer in favor but was largely based on previous studies that demonstrated increased risk for aspiration pneumonia, perforation, diverticulitis, and malignant transformation. 9,[17][18][19] Symptoms of regurgitation and aspiration may correlate with larger diverticula, which can serve as a reservoir for food debris; however, most series have shown poor correlation between symptoms and diverticulum size. Symptoms can more commonly be attributed to accompanying…”