Esophageal intramural pseudodiverticulosis, a rare cause of food impaction: case report and review of the literature

Abstract

Esophageal intramural pseudodiverticulosis (EIPD) is a rare, benign condition of uncertain etiology and pathogenesis, which usually presents with either progressive or intermittent dysphagia. Acute presentation with food impaction, requiring emergency esophago-gastroduodenoscopy (EGD), is rare. We report a case of EIPD presenting as food bolus impaction in an elderly black female. The patient had no previous history of dysphagia or odynophagia. Currently accepted risk factors, such as diabetes mellitus, chronic alcoholism, and reflux esophagitis, were not present in our patient. Emergency EGD established the diagnosis and also dislodged the food bolus. Histopathological evaluation of the mucosa diagnosed co-existent acute candidal infection. Medical treatment with proton pump inhibitor and azole antifungal led to resolution of her symptoms. Review of the literature revealed that stenosis, strictures, perforation, gastro-intestinal bleed, and fistula formation are potential complications of EIPD. Multiple motility abnormalities have been described but are not consistent. Treatment of the underlying inflammatory and or infectious condition is the mainstay of management of this unusual condition.

Esophageal intramural pseudodiverticulosis, an unusual cause of dysphagia: report of a case

“…The sensitivity of both the methods is reported to be the same for diagnosis of EIP [4]. However, other authors argue that the narrow ostia are easier to miss, particularly with older generation endoscopes and propose high-definition endoscopy as the most reliable method to diagnose the condition [2].…”

“…Patients present with progressive dysphagia to solids and chest discomfort, though, the condition remains mostly asymptomatic. The characteristic endoscopic findings of multiple orifices of the esophageal mucosa are only seen in 20 % of the cases, making the condition easily missed [2]. Herein, we report a case of EIP in a patient with a 9-month history of dysphagia, with typical endoscopic findings and successful response to oral antifungal agents alone.…”

Caustic Injury and Stricture of the Esophagus After Long-Term Phenytoin Use

“…Potential complications of EIPD include stenosis, strictures, perforation, bleeding, and fistula formation. 6 The mainstay of management is treatment of the underlying condition and esophageal dilation.…”

Chronic fibrosing esophagitis with diffuse esophageal intramural pseudo‐diverticulosis

“…Food impactions constitute an emergency and should be removed endoscopically. 15,26,27,47,48 Candida infections should always be searched for and, when found, treated according to existing guidelines or standards. 7,13,40,49,50 Since the diverticula probably cause a degree of stasis that may well predispose to chronic infection, it can be hypothesized that this infection causes fibrosis with scarring (see "Histology" above).…”

“…Food impactions constitute an emergency and should be removed endoscopically 15,26,27,47,48 . Candida infections should always be searched for and, when found, treated according to existing guidelines or standards 7,13,40,49,50 .…”