Abstract
BackgroundEpiphrenic esophageal diverticulum is a rare condition that is often associated with a concomitant esophageal motor disorder. Some patients have the chief complaints of swallowing difficulty and gastroesophageal reflux; traditionally, such diverticula have been resected via right thoracotomy. Here, we describe a case with huge multiple epiphrenic diverticula with motility disorder, which were successfully resected using a video-assisted thoracic and laparoscopic procedure.Case presentationA 63-year-old man was admitted due to dysphagia, heartburn, and vomiting. An esophagogram demonstrated an S-shaped lower esophagus with multiple epiphrenic diverticula (75 × 55 mm and 30 × 30 mm) and obstruction by the lower esophageal sphincter (LES). Esophageal manometry showed normal peristaltic contractions in the esophageal body, whereas the LES pressure was high (98.6 mmHg). The pressure vector volume of LES was 23,972 mmHg2 cm. Based on these findings, we diagnosed huge multiple epiphrenic diverticula with a hypertensive lower esophageal sphincter and judged that resection might be required. We performed lower esophagectomy with gastric conduit reconstruction using a video-assisted thoracic and hand-assisted laparoscopic procedure. The postoperative course was uneventful, and the esophagogram demonstrated good passage, with no leakage, stenosis, or diverticula.ConclusionsThe most common causes of mid-esophageal and epiphrenic diverticula are motility disorders of the esophageal body; appropriate treatment should be considered based on the morphological and motility findings.
Highlights
Epiphrenic esophageal diverticulum is a rare condition that is often associated with a concomitant esophageal motor disorder
Previous studies have shown that in the majority of patients (75–100%), epiphrenic diverticula were associated with esophageal achalasia or other esophageal motility disorders, such as diffuse esophageal spasm or a nutcracker esophagus [2,3,4,5]
We report a case with huge multiple epiphrenic diverticula with a hypertensive lower esophageal sphincter (HLES), who was successfully treated with video-assisted thoracic surgeryesophagectomy (VATS-E) with gastric conduit reconstruction by hand-assisted laparoscopic surgery (HALS)
Summary
We here reported a case with multiple epiphrenic esophageal diverticula with HLES, who was successfully treated by VATS-E using gastric conduit reconstruction by the HALS technique. It is important to consider the appropriate treatment of complicated epiphrenic esophageal diverticula when deciding on surgery to cure this condition. Funding The authors declare that this study was not funded externally. Authors’ contributions YT, TT, SH, and KN performed the surgery. KT, YM, TM, YK, MY, ST, MM, and YD conceived of the study, participated in its design and coordination, and helped to draft the manuscript. Competing interests The authors declare that they have no competing interests. Consent for publication Written informed consent was obtained from the patient for publication of this case report and accompanying images. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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