1736 Mega Esophageal Diverticulum Complicated by Post-Operative Esophageal Stricture

Abstract

INTRODUCTION: Esophageal diverticulae are rare outpouchings of the esophagus that occur secondary to underlying motility disorders. On average they measure approximately 7 cm. Here we present a case of mega diverticulum measuring 8.5 cm, complicated by post-operative esophageal stricture. CASE DESCRIPTION/METHODS: Patient is a 58-year old female with a medical history of gastroesophageal reflux disease who presented to our gastroenterology clinic complaining of progressively worsening reflux and weight loss. Given these symptoms, an esophagogastroduodenoscopy (EGD) was scheduled. This was done and showed a large esophageal diverticulum with luminal distortion and retained food in the lower third of the esophagus. Subsequently a barium swallow was ordered to better evaluate the esophagus. This was done and showed an 8.5 × 6.0 cm diverticulum from the right side of the distal esophagus with slight irregularity of the mucosa superior to the diverticulum (Figure 1). The patient was then referred the surgical clinic for possible intervention. After discussing the risks and benefits of treatment the patient agreed to undergo surgical repair consisting of a diverticulectomy. This was done successfully with no postoperative complications. Five days after the procedure a repeat barium swallow was done and showed resolution of the diverticulum with no leakage of barium, but did reveal lower esophageal narrowing with a dilated thoracic esophagus (Figure 2). Following these findings a repeat endoscopy was done which showed a lower esophageal stricture that was treated with balloon dilation (Figure 3). After the procedure the patient was able to tolerate oral intake and was safely discharge home. DISCUSSION: Management of esophageal diverticula depends on the severity of symptoms. In asymptomatic patients a conservative approach may be employed. In symptomatic patients who present with dysphagia, regurgitation, vomiting or chest pain, surgery is the mainstay of treatment. Surgical management consists of diverticulectomy with long myotomy and subsequent fundoplication. Postoperative complications include pulmonary edema, pneumonia, and leakage of barium swallow into the thoracic cavity. Rarely will esophageal narrowing resulting in persistent dysphagia occur. In these cases an endoscopic treatment with balloon dilation should be pursued. Our case highlights a rare presentation of a mega esophageal diverticulum complicated by a post-operative esophageal stricture that was successfully treated with balloon dilation.