Large Epiphrenic Diverticula: A Rare Case Presentation

Abstract

A 70-year old female was admitted to hospital with heartburn and chronic halitosis since 5 years. She was on proton pump inhibitors for the same. Her complaints worsened during the last one-year. Workup comprising of esophago-gastro-duodenoscopy, esophageal manometry, 3D computed tomography scan showed right-sided epiphrenic diverticula measuring 10x10 cm with wide mouth about 5 cm with hypertensive lower esophageal sphincter. Patient underwent a video assisted thoracoscopic surgery for esophageal diverticulectomy using two 45 mm staplers. On day 5, the patient developed leak, which was managed by a covered esophageal stent placement. Patient started on oral feeds from day 3 and the esophageal leak healed completely within 2 weeks. Literature suggests that esophageal leaks treated conservatively took approximately 30-40 days on an average for healing. Literature search did not reveal esophageal leak managed by stent with faster recovery (2 weeks). This is one of the largest epiphrenic diverticuli reported in literature.

Large epiphrenic esophageal diverticulum in symptomatic patient managed laparoscopically: Case report and review of literature

“…Other symptoms involve regurgitation, nausea and vomiting, heartburn, halitosis, hyporexia, weight loss, retrosternal pain, secondary respiratory infections and odynophagia [4] , [12] . Cardiac dysritmias have also been reported in the literature [16] , [17] . Our patient complained specially of reflux and dysphagia, but she also had retrosternal pain and difficult to swallow solid food in association.…”

Giant epiphrenic diverticulum: an unusual case from diagnosis to treatment

“…Other patients may suffer from severe dysphagia, regurgitation, obstruction, heartburn, chronic cough, recurrent aspiration and pneumonia, cardiac arrhythmias, weight loss and halitosis. 5 In the literature, cases of bleeding, carcinoma and/or perforation have also been reported. 6 Differential diagnosis can include condition such as acid reflux, hiatal hernia or tumors, that can be differentiated based on the findings of standard work-up which is based on Barium swallow X-ray with supplemental evaluation including upper endoscopy to exclude malignancy and esophageal manometry to delineate any underlying motility disorder.…”

Robotic-Assisted Transthoracic Esophageal Diverticulectomy

“…There are several management methods for the leak, including reoperation, external drainage, and covered stent placement, which was the choice in our patient in case 2. 3 , 8 …”

“…Although the true incidence is unknown, epiphrenic diverticulum is seen in approximately ∼10 to 20% of patients. 3 , 4 Those affected usually present with dysphagia, halitosis, regurgitation, heartburn, nausea, vomiting, and chest pain. 5 , 6 Surgery is the choice of treatment in patients who have esophageal diverticulum with any of these symptoms.…”