RESUMO
INTRODUCTION: With 250 published cases worldwide, diffuse esophageal intramural pseudo-diverticulosis (DEIPD) is a poorly understood disease. The aim of this study was to determine the prevalence of DEIPD in our own population, identify risk factors and clinical symptoms, and characterize its typical endoscopic signs. METHODS: Retrospective search in our center's endoscopic and clinical database. Reviewing of all cases by re-examining stored endoscopic photographs. Reviewing of all cases regarding age, sex, risk factors, comorbidities, histology, and clinical symptoms. RESULTS: In a population of 150.000 we found 21 cases of DEIPD. Mean age was 56 ± 10 years. 86% were males, 76% had alcohol abuse, 57% had nicotine abuse, 38% had arteriosclerosis, 33% had COPD, 29% had malignancies, 24% had liver cirrhosis, 19% had impaired kidney function, and 15% had diabetes. Dysphagia was present in 62% and food bolus impaction (single or repeated) in 48%. Endoscopically, 95% of patients had multiple (> 4), small (0.25-2.5 mm) pseudodiverticle openings in the esophageal wall. In 62%, openings were aligned longitudinally. 86% showed edematous swelling of mucosa ("frosted glass look"), 76% showed a fine-grained pattern of small (10-100 µm) red dots ("faux uni pattern"), and 76% had a rigid, narrow lumen with multiple rings ("trachealization"). CONCLUSION: With a prevalence of approximately 5 to 50/100.000, DEIPD may be more frequent than previously estimated. It preferably affects middle-aged male alcoholics. Key symptoms are chronic dysphagia and food impaction. Typical endoscopic findings are multiple, small, longitudinally aligned pseudodiverticle openings, frosted glass look, faux uni pattern, and trachealization of the esophagus.
Assuntos
Transtornos de Deglutição/etiologia , Diverticulose Esofágica/diagnóstico , Endoscopia do Sistema Digestório/métodos , Mucosa Esofágica/patologia , Inflamação/diagnóstico , Idoso , Alcoolismo/complicações , Gerenciamento de Dados , Transtornos de Deglutição/epidemiologia , Diagnóstico Diferencial , Diverticulose Esofágica/epidemiologia , Diverticulose Esofágica/patologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Nicotiana/efeitos adversosAssuntos
Transtornos da Motilidade Esofágica/etiologia , Mucosa Esofágica/patologia , Estenose Esofágica/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Inibidores da Bomba de Prótons/administração & dosagem , Biópsia , Diagnóstico Diferencial , Diverticulose Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/tratamento farmacológico , Transtornos da Motilidade Esofágica/patologia , Mucosa Esofágica/diagnóstico por imagem , Estenose Esofágica/tratamento farmacológico , Estenose Esofágica/etiologia , Estenose Esofágica/patologia , Esofagoscopia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/patologia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Esôfago de Barrett/complicações , Diverticulose Esofágica/etiologia , Endoscopia Gastrointestinal/métodos , Endossonografia/métodos , Esofagite Péptica/complicações , Úlcera Péptica/complicações , Esôfago de Barrett/diagnóstico , Diverticulose Esofágica/diagnóstico , Esofagite Péptica/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/diagnósticoRESUMO
UNLABELLED: Esophageal intramural pseudodiverticulosis (EIPD) is a rare disorder in adults, and even more in infants and children. It is characterized by the dilatation of the submucosal esophageal glands. The exact etiology and pathophysiology of EIPD is, however, unknown. Dysphagia is the predominant presenting symptom in both children and adults. CONCLUSION: Here, we present a case of a boy with persistent dysphagia who had a thorough diagnostic workup and was eventually diagnosed with EIPD.
Assuntos
Transtornos de Deglutição/etiologia , Diverticulose Esofágica/complicações , Esôfago/patologia , Refluxo Gastroesofágico/diagnóstico , Criança , Diagnóstico Diferencial , Diverticulose Esofágica/diagnóstico , Humanos , Masculino , Manometria/métodosRESUMO
Intramural pseudodiverticulosis of the esophagus is a rare benign disease of the eosphageal wall, with dilation of the submucosal glands, and the predominant symptom is dysphagia. This disorder may be associated with gastroesophageal reflux, motility disorders, candidiasis and alcoholism. Inflammation, resulting in periductal fibrosis and compression of the duct orifices, may be a causative factor. Good and long-lasting therapeutic success can be achieved by bouginage of the stenosis with concomitant treatment of the associated esophageal diseases. Esophageal intramural pseudodiverticulosis is a differential diagnosis in cases of dyspagia and/or esophageal strictures if no other causes are found.
Assuntos
Transtornos de Deglutição/etiologia , Diverticulose Esofágica/diagnóstico , Estenose Esofágica/etiologia , Idoso , Humanos , Masculino , RecidivaRESUMO
Esophageal intramural pseudo-diverticulosis is a rare disease of unknown etiology. It is characterized by multiple pseudodiverticula with segmental or diffuse involvement of the esophagus. We report, the case of a 78-year-old male who suffered from severe dysphagia. Diagnosis of esophageal intramural pseudo-diverticulosis was based on endoscopic and radiologic explorations. Histological analysis of esophageal mucosal biopsies has shown the presence of candida albicans. Antifungal treatment leads to spectacular improvement of dysphasia. Subsequently, the patient presented a cardio-respiratory failure and died despite adequate treatment.
Assuntos
Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Transtornos de Deglutição/diagnóstico , Diverticulose Esofágica/diagnóstico , Idoso , Antifúngicos/administração & dosagem , Candidíase/tratamento farmacológico , Transtornos de Deglutição/tratamento farmacológico , Humanos , MasculinoRESUMO
Dysphagia is a common complaint of patients seen at the outpatient clinic as well as at the emergency room. We report esophageal intramural pseudodiverticulosis (EIPD) as a cause of dysphagia that is less known by physicians and it is rarely described in the literature. EIPD is characterized by multiple, segmental or diffuse, flask-like outpouchings in the esophageal wall corresponding to dilated and inflamed excretory ducts of the submucosal esophageal glands. The underlying etiology remains unclear. Esophageal strictures, esophageal candidiasis and gastroesophageal reflux disease are often associated. The diagnosis can be made by upper gastrointestinal endoscopy, but barium esophagography is the modality of choice. Complications of EIPD are rare and include broncho-esophageal and esophagomediastinal fistula, pleural and pericardial effusion, abscesses, gastrointestinal bleeding from a web-like stenosis or esophageal perforation with pneumomediastinum. The treatment for EIPD should be directed towards treating underlying associated conditions and relieving symptoms rather than the pseudodiverticulosis itself.
Assuntos
Diverticulose Esofágica/diagnóstico , Perfuração Esofágica/diagnóstico por imagem , Estenose Esofágica/diagnóstico por imagem , Enfisema Mediastínico/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Diverticulose Esofágica/complicações , Endoscopia do Sistema Digestório , Doenças do Esôfago/complicações , Doenças do Esôfago/diagnóstico , Perfuração Esofágica/complicações , Estenose Esofágica/complicações , Humanos , Masculino , Enfisema Mediastínico/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Esophageal diverticula can cause disabling symptoms. The authors describe here our preferred surgical approach for Zenker's and epi-phrenic diverticula. For most patients, excision of the diverticulum and addition of a myotomy will result in a favorable functional outcome and a low recurrence rate.
Assuntos
Diverticulose Esofágica/fisiopatologia , Esofagoscopia/métodos , Diverticulose Esofágica/diagnóstico , Diverticulose Esofágica/cirurgia , HumanosRESUMO
A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer (T3N2M0 Stage III) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation, including redness, erosion, edema, bleeding, friability, and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine, gastrografin-filled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly, endoscopic balloon dilatation was performed and anti-fungal therapy was started in the hospital. Seven weeks later, endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently, the patient was discharged. At the latest follow-up, the patient was symptom-free and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.
Assuntos
Diverticulose Esofágica/etiologia , Divertículo Esofágico/etiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Biópsia , Candida glabrata/isolamento & purificação , Candidíase/microbiologia , Transtornos de Deglutição/etiologia , Dilatação , Diverticulose Esofágica/diagnóstico , Diverticulose Esofágica/microbiologia , Diverticulose Esofágica/terapia , Divertículo Esofágico/diagnóstico , Divertículo Esofágico/microbiologia , Divertículo Esofágico/terapia , Neoplasias Esofágicas/patologia , Estenose Esofágica/etiologia , Esofagoscopia , Humanos , Masculino , Estadiamento de Neoplasias , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Pulsion diverticulae of the mid-esophagus with unknown etiology are usually asymptomatic and therefore considered incidental findings on chest X-rays, barium swallows, or endoscopic procedures. Diagnosis is often delayed due to the rarity of clinical symptoms. The clinical, radiological, etiological and surgical features in a patient with extraordinary symptomatic giant mid-esophageal pulsion diverticulum with history of alkali ingestion are presented here. Alkali injury may yield asymptomatic strictures and/or acquired weaknesses of the esophageal wall, both of which are known to lead to the formation of this giant malady. Putative pathomechanism and suggested therapy including diverticulectomy is proposed in this communication.
Assuntos
Álcalis/efeitos adversos , Diverticulose Esofágica/diagnóstico , Diverticulose Esofágica/etiologia , Idoso , Diverticulose Esofágica/terapia , Divertículo/patologia , Endoscopia , Esôfago/patologia , Feminino , Humanos , Tomografia Computadorizada por Raios XRESUMO
We report the case of a 70-year old man with recurrent pneumonia due to aspiration from an otherwise asymptomatic small oesophageal diverticula in the mid-oesophageal region. The diagnosis was finally established by videofluoroscopy of the oesophagus after repeated bronchoscopies and CT scans in the proceeding months. After thoracoscopic removal of the diverticula the patient remained free of disease. Oesophageal diverticula as a rare cause of repeated pneumonias should be kept in mind, even though there are no symptoms of gastro-oesophageal disease.
Assuntos
Diverticulose Esofágica/diagnóstico , Pneumonia Aspirativa/diagnóstico , Pneumonia/etiologia , Idoso , Broncoscopia , Diagnóstico Diferencial , Diverticulose Esofágica/complicações , Fluoroscopia , Humanos , Masculino , Pneumonia/diagnóstico , Pneumonia Aspirativa/etiologia , Recidiva , Tomografia Computadorizada por Raios X , Gravação em VídeoAssuntos
Diverticulose Esofágica/complicações , Esofagite/complicações , Hérnia Diafragmática/complicações , Síndrome de Mallory-Weiss/etiologia , Diagnóstico Diferencial , Diverticulose Esofágica/diagnóstico , Endoscopia Gastrointestinal/métodos , Esofagite/diagnóstico , Hérnia Diafragmática/diagnóstico , Humanos , Síndrome de Mallory-Weiss/diagnósticoAssuntos
Transtornos de Deglutição/etiologia , Diverticulose Esofágica/complicações , Estenose Esofágica/etiologia , Candidíase/complicações , Candidíase/diagnóstico , Diagnóstico Diferencial , Diverticulose Esofágica/diagnóstico , Neoplasias Esofágicas/diagnóstico , Esofagite/complicações , Esofagite/diagnóstico , Esofagoscopia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We here report a rare case of esophageal intramural pseudodiverticulosis with dysphagia. A 65-year-old man was suffering from intermittent dysphagia for 10 years, which had been worsening in recent months. Endoscopic examination revealed multiple, small, saccular diverticula and mild annular stricture with numerous white plaques from the cervical esophagus to the middle thoracic esophagus. Barium esophagography revealed stricture of the upper thoracic esophagus with multiple tiny flask-shaped outpouchings. Based on this characteristic appearance, we diagnosed esophageal intramural pseudodiverticulosis and inflammation of a narrow segment of the esophagus. Biopsy specimen showed acute and chronic esophagitis with Candida infection. Dysphagia persisted despite resolution of candidiasis, for which we successfully performed endoscopic balloon dilatation of the stricture. After the treatment, the patient has been well and has not been suffering from dysphagia.
Assuntos
Dilatação/métodos , Diverticulose Esofágica/terapia , Endoscopia do Sistema Digestório/métodos , Idoso , Candidíase , Doença Crônica , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Progressão da Doença , Diverticulose Esofágica/complicações , Diverticulose Esofágica/diagnóstico , Estenose Esofágica/etiologia , Estenose Esofágica/terapia , Esofagite/complicações , Esofagite/diagnóstico , Esofagite/microbiologia , Esofagite/patologia , Humanos , Masculino , Resultado do TratamentoRESUMO
Esophageal intramural pseudodiverticulosis is a rare pathology whose etiology is unknown, but which is frequently associated with three highly prevalent entities: esophageal reflux disease, esophageal candidosis and alcoholic esophagitis. With conservative treatment the course of these pathologies is usually benign. However, some severe cases are resistant to conservative treatment and may require more aggressive management. We here present the case of patient suffering from a severe esophagitis complicated by chronic mediastinitis with life-threatening repercussions, requiring esophagectomy as treatment.
La pseudodiverticulose Åsophagienne intramurale est une pathologie rare, d'étiologie inconnue, mais fréquemment associée à trois entités hautement prévalentes: la maladie de reflux, la candidose Åsophagienne et l'Åsophagite alcoolique. L'évolution de ces pathologies est habituellement bénigne avec un traitement conservateur. Certains cas sévères nécessitent toutefois une prise en charge plus agressive. Nous présentons ici le cas d'un patient souffrant d'une Åsophagite sévère compliquée d'une médiastinite chronique avec des répercussions menaçant sa survie, ayant nécessité une prise en charge chirurgicale agressive.
Assuntos
Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/diagnóstico , Estenose Esofágica/diagnóstico , Esofagite/diagnóstico , Candidíase/diagnóstico , Candidíase/patologia , Candidíase/cirurgia , Doença Crônica , Transtornos de Deglutição/patologia , Transtornos de Deglutição/cirurgia , Diagnóstico Diferencial , Diverticulose Esofágica/diagnóstico , Diverticulose Esofágica/patologia , Diverticulose Esofágica/cirurgia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Estenose Esofágica/patologia , Estenose Esofágica/cirurgia , Esofagectomia , Esofagite/patologia , Esofagite/cirurgia , Esofagoscopia , Esôfago/patologia , Humanos , Masculino , Mediastinite/diagnóstico , Mediastinite/patologia , Mediastinite/cirurgia , Pessoa de Meia-IdadeAssuntos
Diverticulose Esofágica/diagnóstico , Endoscopia Gastrointestinal/métodos , Radiografia Torácica/métodos , Administração Oral , Sulfato de Bário/administração & dosagem , Biópsia , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Dilatação/métodos , Diverticulose Esofágica/terapia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Diverticulose Esofágica/complicações , Diverticulose Esofágica/diagnóstico , Diverticulose Esofágica/cirurgia , Transtornos de Deglutição/complicações , Transtornos de Deglutição/etiologia , Transtornos de Deglutição , Gastroscopia/métodos , Gastroscopia/tendências , Diverticulose Esofágica/fisiopatologia , Diverticulose Esofágica , Transtornos de Deglutição/fisiopatologia , Manometria/métodos , ManometriaRESUMO
This report describes the clinical course of a patient with complications of esophageal intramural pseudodiverticulosis. The condition led to fistulization and abscess formation in the mediastinum. The initial presentation was for the septic process and appropriate antibiotic therapy led to infection control while the abscess drained spontaneously back into the esophageal lumen. A long stricture affecting the distal half of the esophagus became evident after a few months and could not be managed by repeat dilatations. After appropriate preparation, subtotal esophagectomy was offered to the patient with an initial right thoracic approach followed by laparotomy and left cervical reconstruction. A total gastric tube was used for reconstruction and placed in a substernal position. An uneventful postoperative evolution led to normal swallowing comfort.