S2168 A Rare Cause of Progressive Dysphagia

Abstract

Introduction: Esophageal diverticulum is a rare entity resulting from outpouching of the mucosa through the muscularis layer. Often times patients present with symptoms of dysphagia or regurgitation. We present an unusual case of long-standing dysphagia as a complication of prior cervical discectomy and fusion. Case Description/Methods: 73-year-old female presented with a one-year history of progressive dysphagia to solids and liquids. Her past medical history was significant for cervical degenerative joint disease status post anterior cervical discectomy and fusion 13 years ago, as well as breast cancer treated with chemoradiation about 4 years prior. A barium esophagram demonstrated a large filling diverticulum in the upper esophagus consistent with a Zenker’s diverticulum. Further endoscopic evaluation revealed a small esophageal diverticulum with evidence of a metal plate and screws within the diverticulum (Image A). Her long-standing symptoms were likely due to the perforating hardware rather than the small size diverticulum. She underwent surgical removal of previous hardware with repair of the diverticulum. Intraoperative findings were consistent with a traction diverticulum. Discussion: Esophageal diverticula can be characterized based on their mechanism of formation. A traction diverticulum occurs secondary to an external force which adheres and pulls the wall of the esophagus creating a defect. Conversely pulsion diverticulum, a Zenker diverticulum, is formed due to increased intraluminal pressure resulting in the outpouching.Figure 1.: Endoscopic image of esophageal diverticulum with screws and metal plate.