SESSION TITLE: Bacterial Infections 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Often in their search for the culprit responsible for recurrent aspiration pneumonia (PNA), clinicians turn to neurological etiologies, leaving their investigation for gastrointestinal causes limited to ruling-out oropharyngeal dysphagia with videofluoroscopic swallow evaluations. An uncommon etiology of recurrent aspiration is the presence of an esophageal diverticulum. Accounting for <1% of barium GI radiographs and <5% of dysphagia cases1, it is understandable that this uncommon cause may not be included in a practitioner’s differential. As such, the following case highlights signs and symptoms of PNA cause by this abnormality, surgical means of correction, and the resulting reduction in recurrent aspiration PNA that may be seen by addressing this problem. CASE PRESENTATION: 62-yo man presented for his fifth hospitalization for PNA over the past year. He complained of dysphagia for 1 year. He noted halitosis, cough, and heartburn. He denied any difficulty chewing or swallowing, drooling, dysarthria or odynophagia. Physical exam was unremarkable except for halitosis. Bedside and videofluoroscopic oropharyngeal swallow studies showed no causes for dysphagia while bronchoscopy ruled-out intrapulmonary etiologies. Barium swallow showed a 7.7x7cm distal esophageal diverticulum with inferior esophageal narrowing caused by mass effect. Contrast collected within the diverticulum, remaining there until the esophagus cleared, followed by its reflux into the esophagus. EGD visualized the food filled diverticulum and no esophageal strictures. Thoracic surgery performed an epiphrenic esophageal diverticulectomy. By 1 month post-surgery, the patient’s dysphagia resolved while 2 month follow-up showed control of his reflux on low-dose PPI. Six months post-op, he denied subsequent episodes of PNA. A motility study later showed a hypertensive LES which was the likely etiology of the diverticulum itself. DISCUSSION: Epiphrenic diverticula are not easily detected and often mistaken for hiatal hernias. Therefore, a high index-of-suspicion is needed. Though most asymptomatic esophageal diverticula do not require it, treatment of epiphrenic diverticula involves treating the causative dysmotility with pneumatic dilations, Botox injections to the LES, or Hellar esophagomyotomies. Diverticulectomies are reserved for cases suspected of causing aspiration PNA. CONCLUSIONS: Among the top 8 causes of mortality, PNA accounts for > 1 million discharges averaging a 5.2 day length-of-stay in hospitals nationwide. Though only a single case, if reflective of the potential savings in overall healthcare costs- from financial savings of reduced hospitalizations, to limiting antibiotic resistance, to curbing morbidity and mortality- the benefits of diagnosing/treating such structural and functional abnormalities are definitely worthy of further study. Reference #1: Achkar E. Esophageal Diverticula. Gastroenterology & Hepatology. 2008;4(10):691-693. DISCLOSURE: The following authors have nothing to disclose: Vandana Pai, Kim Phung Nguyen, Harika Balagoni, Jennifer Treece, Allison Locke No Product/Research Disclosure Information