RESUMO
A 54-year-old woman was referred for assessment of dysphagia and extrinsic compression of the esophagus detected by upper gastrointestinal endoscopy. Computed tomography revealed the rightsided aortic arch with mirror image branching and Kommerell's diverticulum. To relieve the esophageal compression, surgical intervention was indicated. Descending aortic replacement with a Dacron graft was performed through right thoracotomy under partial cardiopulmonary bypass. The patient was discharged without any complication, and her dysphagia disappeared.
Assuntos
Aorta Torácica/anormalidades , Transtornos de Deglutição/cirurgia , Diverticulose Esofágica/cirurgia , Esôfago , Aorta Torácica/cirurgia , Ponte Cardiopulmonar/métodos , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Transtornos de Deglutição/etiologia , Diverticulose Esofágica/complicações , Diverticulose Esofágica/diagnóstico por imagem , Esôfago/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Toracotomia , Tomografia Computadorizada por Raios XRESUMO
Peoral endoscopic myotomy (POEM) has been proved to be safe and effective for treating achalasia, however the presence of esophageal diverticulum would increase the technical difficulty. In this letter, we firstly report a case regarding POEM for achalasia with concomitant multiple esophageal diverticulums.
Assuntos
Diverticulose Esofágica/cirurgia , Divertículo Esofágico/cirurgia , Endoscopia Gastrointestinal/métodos , Acalasia Esofágica/complicações , Diverticulose Esofágica/diagnóstico por imagem , Diverticulose Esofágica/etiologia , Divertículo Esofágico/diagnóstico por imagem , Endoscopia do Sistema Digestório , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The results of operative treatment of 122 patients for stenosing diseases of the esoph- agus during 1993-2014 yrs period were analyzed. The expediency of application of the technology proposed was proved.
Assuntos
Queimaduras Químicas/cirurgia , Constrição Patológica/cirurgia , Diverticulose Esofágica/cirurgia , Neoplasias Esofágicas/cirurgia , Esôfago/cirurgia , Leiomioma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras Químicas/patologia , Constrição Patológica/patologia , Diverticulose Esofágica/patologia , Neoplasias Esofágicas/patologia , Esôfago/patologia , Feminino , Humanos , Leiomioma/patologia , Masculino , Pessoa de Meia-Idade , Pleurisia/etiologia , Pleurisia/patologia , Pneumonia/etiologia , Pneumonia/patologia , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
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
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 , Diverticulose Esofágica/cirurgia , Estenose Esofágica/diagnóstico , Estenose Esofágica/cirurgia , Adulto , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Diverticulose Esofágica/complicações , Estenose Esofágica/etiologia , Esofagoscopia/métodos , Seguimentos , Gastroscopia/métodos , Humanos , Masculino , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/etiologia , Recuperação de Função Fisiológica , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Benign esophageal lesions are rare conditions and tumors account for about 10% of all esophageal neoplasms. Epiphrenic diverticula occur in the distal esophagus (the lower 10 cm). Currently, thoracotomy/thoracoscopy is the most popular approach for these conditions. We present our experience of 13 patients (1994-2006) with benign supra-diaphragmatic esophageal lesions that we treated with a laparoscopic transhiatal approach. The lesions included in the series were lower esophageal tumors (n = 8) and epiphrenic diverticula (n = 5). Laparoscopic transhiatal stapler excisions of diverticulum and enucleation of tumors were performed for all patients. Intra-operative endoscopy was used in all the procedures. All patients had an uneventful recovery except one with posterior diverticulum, who had an anastomotic leak. He had a prolonged hospital stay and recovered eventually. There was no mortality. Benign lesions of the lower third of the esophagus can be adequately treated through the transhiatal route. This is probably superior to the traditional approaches of thoracotomy/thoracoscopy as it does away with increased morbidity while maintaining adequate access. An endoscopy is of great value in localizing the lesion and assessing the esophageal lumen size during the application of staples. A laparoscopic transhiatal excision is technically feasible for all benign supra-diaphragmatic lesions and epiphrenic diverticula and is the approach of choice.
Assuntos
Diverticulose Esofágica/cirurgia , Neoplasias Esofágicas/cirurgia , Laparoscopia , Adulto , Diafragma , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , ToracoscopiaRESUMO
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.
Assuntos
Diverticulose Esofágica/complicações , Diverticulose Esofágica/cirurgia , Esofagectomia , Abscesso/etiologia , Abscesso/terapia , Antibacterianos/uso terapêutico , Candida albicans/isolamento & purificação , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Diverticulose Esofágica/diagnóstico , Estenose Esofágica/etiologia , Estenose Esofágica/terapia , Fístula/etiologia , Fístula/terapia , Humanos , Masculino , Doenças do Mediastino/etiologia , Doenças do Mediastino/terapia , Pessoa de Meia-Idade , Escarro/microbiologiaRESUMO
Chest pain is an uncommon cause of consultation in childhood and is even less frequent if resulting from digestive causes. We present the cases of two patients with gastrointestinal tract malformations (diverticulum and esophageal duplication cyst) diagnosed after investigation of chest pain. A potential etiology of diverticulum could be a traction effect caused by fibrous adenopathy of tuberculous primary infection. Duplication cysts are inborn defects. Although these malformations are uncommon, clinicians should take them into account in patients with chest pain.
Assuntos
Dor no Peito/etiologia , Diverticulose Esofágica/complicações , Cisto Esofágico/complicações , Criança , Pré-Escolar , Diverticulose Esofágica/diagnóstico por imagem , Diverticulose Esofágica/cirurgia , Cisto Esofágico/diagnóstico por imagem , Cisto Esofágico/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
We report a rare case of esophageal intramural pseudodiverticulosis with perforation of the esophagus. A 32-year-old male presented with acute thoracal pain after a period of vomiting. Computed tomography revealed an important amount of mediastinal free air and small outpouchings in the wall of the esophagus. During the following thoracic surgery procedure no macroscopic site of rupture could be identified. Pseudodiverticulosis was detected during a barium swallow exam of the esophagus 4 weeks later.
Assuntos
Diverticulose Esofágica/diagnóstico por imagem , Enfisema Mediastínico/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Dor no Peito/etiologia , Dor no Peito/cirurgia , Diagnóstico Diferencial , Diverticulose Esofágica/cirurgia , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/cirurgia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Humanos , Masculino , Enfisema Mediastínico/cirurgia , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/cirurgiaRESUMO
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.