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2.
Clin J Gastroenterol ; 12(4): 292-295, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30697669

RESUMO

Esophageal intramural pseudodiverticulosis (EIPD) is an uncommon benign disorder leading to esophageal strictures. The etiology remains unknown; however, anti-fungal treatments or endoscopic balloon dilation can improve early esophageal strictures and these rarely require surgical treatment. We report a case of a 46-year-old male with a 6 cm-long esophageal stricture due to EIPD, which did not improve following treatment with an anti-fungal agent, eventually causing aspiration pneumonia. Therefore, we performed a thoraco-laparoscopic esophagectomy, and his symptoms were improved after surgery. This case suggests that a surgical treatment should be considered in patients with extensive, severe strictures attributable to EIPD.


Assuntos
Divertículo Esofágico/cirurgia , Estenose Esofágica/cirurgia , Esofagectomia/métodos , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Divertículo Esofágico/complicações , Divertículo Esofágico/diagnóstico por imagem , Divertículo Esofágico/patologia , Endossonografia , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/etiologia , Estenose Esofágica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Tomografia Computadorizada por Raios X
4.
Asian J Endosc Surg ; 12(2): 167-170, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29888543

RESUMO

Controversy remains regarding the optimal resection approach for Siewert type II adenocarcinoma of the esophagogastric junction (EGJ). Furthermore, an esophageal diverticulum, although rare, can complicate surgical procedures. Herein, we report a case of EGJ adenocarcinoma with an esophageal diverticulum that was treated using the minimally invasive abdominal and left thoracic approach (MALTA). A 72-year-old man, with EGJ adenocarcinoma and an epiphrenic diverticulum on esophagogastroduodenoscopy underwent endoscopic submucosal dissection. The pathological diagnosis of the specimen revealed invasion to the lymphatic vessels. Therefore, laparoscopic proximal gastrectomy and thoracoscopic lower esophagectomy with D1 lymph node dissection and double-tract reconstruction of the esophageal diverticulum were performed via MALTA. The patient was discharged without any postoperative morbidity. MALTA provides good visualization for the transection of the lower esophagus in cases of esophageal diverticulum. Moreover, MALTA for adenocarcinoma of the EGJ is technically feasible, even with the presence of a lower esophageal diverticulum.


Assuntos
Adenocarcinoma/cirurgia , Divertículo Esofágico/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Idoso , Meios de Contraste , Divertículo Esofágico/diagnóstico por imagem , Divertículo Esofágico/patologia , Ressecção Endoscópica de Mucosa , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Esofagectomia , Junção Esofagogástrica/diagnóstico por imagem , Junção Esofagogástrica/patologia , Gastrectomia , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Reconstrutivos , Tomografia Computadorizada por Raios X
7.
Ann Thorac Surg ; 106(6): e309-e311, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29859150

RESUMO

This report describes a case of esophageal intramural pseudodiverticulosis associated with an inflammatory esophageal mass with high 18F-fluorodeoxyglucose (FDG) uptake. A 48-year-old man presented with dysphagia caused by an esophageal stricture. Simultaneous positron emission tomography and magnetic resonance imaging showed an FDG-avid lesion in the lower esophagus. Because of suspected malignancy, the patient underwent subtotal esophagectomy. Histologic examination confirmed the diagnosis of an inflammatory tumor associated with esophageal pseudodiverticulosis. Unlike typical cases, this patient's pseudodiverticula involved both the submucosa and the muscularis propria. This case suggests that esophageal intramural pseudodiverticulosis can manifest with a tumorlike mass that may be FDG positive in response to associated inflammation.


Assuntos
Divertículo Esofágico/diagnóstico por imagem , Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Diagnóstico Diferencial , Divertículo Esofágico/patologia , Doenças do Esôfago/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
9.
BMC Gastroenterol ; 17(1): 94, 2017 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-28784105

RESUMO

BACKGROUND: We report a unique case of a superficial esophageal cancer arising in a single diverticulum, diagnosed with magnifying image-enhanced endoscopy and then successfully treated by endoscopic submucosal dissection (ESD). CASE PRESENTATION: A 66-year-old man with alcohol-related liver injury visited our hospital for endoscopy for investigation of varix. Esophagogastroduodenoscopy showed no varix but a large epiphrenic diverticulum with an area of fainted redness just above the esophagogastric junction. Narrow band imaging revealed a sharply demarcated brownish dotted area, and dilated intra-epithelial papillary capillary loops (IPCL) were subsequently seen after magnification. Chromoendoscopy with 1% Lugol's iodine solution demonstrated a well-demarcated unstained area, approximately 20 mm in diameter. Endoscopic biopsy revealed a squamous cell carcinoma (SCC). CONCLUSION: The tumor was completely resected by ESD without perforation. Histologically, it was an intraepithelial SCC without lympho-vascular invasion of cancer cells. No local recurrence or metastasis was detected at the last follow-up of 42 months.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Divertículo Esofágico/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Esofágicas/cirurgia , Idoso , Carcinoma de Células Escamosas/patologia , Divertículo Esofágico/patologia , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago , Humanos , Masculino
10.
J Laryngol Otol ; 131(8): 661-666, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28625183

RESUMO

BACKGROUND: Pharyngoesophageal diverticula have many subtypes, with Zenker's diverticulum being the most common. First described in 1983, a Killian-Jamieson diverticulum is an outpouching in the anterolateral wall at the pharyngoesophageal junction. This is located inferiorly to the cricopharyngeus muscle, unlike Zenker's diverticula which occur superiorly. Killian-Jamieson diverticula are rare and are commonly misdiagnosed as Zenker's diverticula. Less than 30 reports of Killian-Jamieson diverticula have been described in the literature. CASE REPORT: A 69-year-old man presented with a 2-year symptomatic history, and was found to have simultaneous Zenker's diverticulum and Killian-Jamieson diverticulum. He was treated successfully with open surgical excision of both pouches. CONCLUSION: Zenker's diverticulum and Killian-Jamieson diverticulum are diagnosed using radiological studies and endoscopy. Their differentiation is important, as surgical management differs. This paper reviews the literature on Killian-Jamieson diverticula and the management options available.


Assuntos
Divertículo Esofágico/complicações , Divertículo de Zenker/complicações , Idoso , Divertículo Esofágico/patologia , Divertículo Esofágico/cirurgia , Esôfago/patologia , Esôfago/cirurgia , Humanos , Masculino , Faringe/patologia , Faringe/cirurgia , Divertículo de Zenker/patologia , Divertículo de Zenker/cirurgia
11.
Ann Thorac Surg ; 103(4): e365-e367, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28359500

RESUMO

We describe a new video-assisted technique for the management of a giant midesophageal diverticulum using a single 5-cm port. It maintained the same principles of the traditional open technique as diverticulectomy, myotomy, and fundoplication. The better visualization of the main esophageal body, diverticulum, and esophagogastric junction and the better alignment of the stapler cartridge to the longitudinal axis of the esophagus are all technical factors supporting our procedure. Heavily calcified mediastinal lymph nodes and diffuse pleural adhesions are the main contraindications. However, future experiences are needed before this technique can be recommended as acceptable treatment.


Assuntos
Divertículo Esofágico/patologia , Divertículo Esofágico/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Humanos , Masculino , Pessoa de Meia-Idade
14.
Ann Thorac Surg ; 101(2): 769-71, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26777939

RESUMO

More than 50 years ago, two investigators described a rare case of multiple esophageal diverticula, which they named esophageal intramural pseudodiverticulosis (EIPD). To this day, the pathogenesis of this condition remains obscure. Several coexisting conditions, such as strictures, esophageal dysmotility, or infection, require medical treatment. We present two typical cases of EIPD and one case of a rare single esophageal intramural diverticulum.


Assuntos
Divertículo Esofágico/patologia , Criança , Divertículo Esofágico/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Dysphagia ; 31(4): 587-91, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26753928

RESUMO

Killian-Jamieson diverticulum is a outpouching of the lateral cervical esophageal wall adjacent to the insertion of the recurrent laryngeal to the larynx and is much less common in clinical practice than Zenkers Diverticulum. Surgical management of Killian-Jamieson diverticulum requires open transcervical diverticulectomy due to the proximity of the recurrent laryngeal nerve to the base of the pouch. We present a case of a Killian-Jamieson diverticulum associated with a concurrent large type III paraesophageal hernia causing significant solid-food dysphagia, post-prandial regurgitation of solid foods, and chronic cough managed with open transcervical diverticulectomy and laparoscopic paraesophageal hernia repair with Nissen fundoplication.


Assuntos
Tosse/etiologia , Transtornos de Deglutição/etiologia , Divertículo Esofágico/complicações , Hérnia Hiatal/complicações , Refluxo Laringofaríngeo/etiologia , Divertículo Esofágico/patologia , Esôfago/patologia , Hérnia Hiatal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Laríngeo Recorrente/patologia
16.
Harefuah ; 154(8): 499-502, 541, 2015 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-26480613

RESUMO

Epiphrenic diverticulum of the esophagus is an uncommon finding. Small diverticula are usually asymptomatic in nature. Large diverticula may present with dysphagia, chest or upper abdominal discomfort, vomiting, irritating cough or halitosis. There are a few different surgical approaches to epiphrenic diverticulum resection. It can be performed with an abdominal or a thoracic approach and in an open or a laparoscopic manner. In this case report we present a 70 years old male patient with a giant epiphrenic diverticulum and dysphagia. The patient was operated upon via a laparoscopic abdominal approach with intra-operative endoscopic assistance and underwent a diverticulum resection. We present a review of the different kinds of esophageal diverticula, the mechanism of their formation, and the surgical considerations associated with choosing the appropriate surgical approach.


Assuntos
Transtornos de Deglutição/etiologia , Divertículo Esofágico/cirurgia , Laparoscopia/métodos , Idoso , Divertículo Esofágico/patologia , Humanos , Masculino
18.
Chirurgia (Bucur) ; 110(1): 72-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25800320

RESUMO

INTRODUCTION: Epiphrenic diverticula (ED) represent about 20% of oesophageal diverticula. They are considered to be pulsion diverticula, characterized by out pouchings of the oesophageal mucosa originating in the distal 10 cm of the oesophagus and are frequently associated with spastic oesophageal dysmotility. The most frequent clinical manifestations of ED are dysphagia, regurgitations and chest pain. Only symptomatic diverticula should be treated by surgery. The surgical procedure can be performed minimally invasively by robotic approach and consists of diverticulectomy,hiatus calibration and an antireflux procedure, usually adding an esophagomiotomy as well. CASE-REPORT: We present the case of 43-year-old male patient who was admitted for a four-month history of epigastric pain, pyrosis and regurgitations. Preoperative investigation shave shown an epiphrenic diverticulum 6 cm large in diameter.A robotic-assisted transhiatal diverticulectomy with a linear endostapler, hiatal calibration and a Nissen-Rossetti fundoplication were performed using a three-arm da Vinci Robotic System. Operative time was 150 min. Postoperative course was uneventful and the patient was discharged on postoperative day 9, without complications. Ten days later,he came back and was readmitted under emergency status for right chest pain, dyspnoea and fetid breath, being diagnosed with a right empyema secondary to a delayed fistula of the oesophageal suture line. A right minimal pleurotomy and pleural drainage under local anaesthesia were performed and an intravenous antibiotherapy was started with complete remission of symptomatology, the patient remaining asymptomatic after 18 months of follow-up. CONCLUSIONS: Robotic approach is a feasible and safe minimally invasive surgical option in the treatment of selected cases of ED. We consider transhiatal abdominal robotic approach possible in almost all cases of ED, regardless of size,thus avoiding thoracic approach and its possible major complications.The most common serious complication after surgery of ED is post diverticulectomy suture line fistula, but if properly and rapidly diagnosed it could be conservatively treated with very good results.


Assuntos
Divertículo Esofágico/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Fundoplicatura , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos , Adulto , Dor no Peito/etiologia , Transtornos de Deglutição/etiologia , Divertículo Esofágico/complicações , Divertículo Esofágico/patologia , Fundoplicatura/métodos , Humanos , Refluxo Laringofaríngeo/etiologia , Masculino , Resultado do Tratamento
20.
Pathologe ; 34(2): 94-104, 2013 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-23423505

RESUMO

Esophageal malformations are rare and can occur sporadically or as a component of various syndromes. The variations and classifications are manifold. With the available modern operation techniques most malformations can be resolved with good results. However, esophageal malformations are often combined with further malformations which limit the prognosis. The separation of the trachea and esophagus after gastrulation is not yet completely researched. The results so far indicate that the localized expression of various homeodomain transcription factors is essential for normal development of the trachea and esophagus.


Assuntos
Esôfago/anormalidades , Esôfago/patologia , Anastomose Cirúrgica , Doenças em Gêmeos/diagnóstico , Doenças em Gêmeos/genética , Doenças em Gêmeos/patologia , Doenças em Gêmeos/cirurgia , Divertículo Esofágico/diagnóstico , Divertículo Esofágico/genética , Divertículo Esofágico/patologia , Divertículo Esofágico/cirurgia , Atresia Esofágica/diagnóstico , Atresia Esofágica/genética , Atresia Esofágica/patologia , Atresia Esofágica/cirurgia , Esôfago/embriologia , Esôfago/cirurgia , Feminino , Loci Gênicos/genética , Humanos , Lactente , Recém-Nascido , Masculino , Fenótipo , Prognóstico , Síndrome , Traqueia/anormalidades , Traqueia/embriologia , Traqueia/patologia , Traqueia/cirurgia , Fístula Traqueoesofágica/diagnóstico , Fístula Traqueoesofágica/genética , Fístula Traqueoesofágica/patologia , Fístula Traqueoesofágica/cirurgia
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