OJTS  Vol.2 No.4 , December 2012
Surgical Management of Two Simultaneously Occurring Epiphrenic Esophageal Diverticula
Among all diverticula of the esophagus, epiphrenic diverticula occur less frequently than those in the pharyngo-esophageal segment. Two simultaneously occurring diverticula in the epiphrenic esophagus are very rarely reported in the English literature. A 52-year-old woman had a 3-year history of troublesome dysphagia, heartburn, chest pain and cough. Initial investigation included a physical examination and a barium swallow, which showed the presence of two diverticula in the epiphrenic esophagus. Esophagoscopy confirmed the presence only of the lower diverticulum. The patient underwent a left thoracotomy, the esophagus was mobilised from the hiatus to the aortic arch. The necks of the diverticula were localised in the posterior wall and between them there was a bridge of circular muscular fibres, which was divided. Diverticulectomy over an intra-esophageal 54 F Maloney dilator was performed. The upper diverticulum was left intact because it disappeared after the bridge of esophageal muscles has been myotomized. A long myotomy was carried out, and a modified Belsey fundoplication was added. The postoperative course was uneventful, and the patient remains well at 10 years with no recurrence of symptoms.

Cite this paper
M. Migliore, G. Pulvirenti, D. Calvo, A. Criscione, M. Gangemi, F. Borrata and D. Palumbo, "Surgical Management of Two Simultaneously Occurring Epiphrenic Esophageal Diverticula," Open Journal of Thoracic Surgery, Vol. 2 No. 4, 2012, pp. 91-93. doi: 10.4236/ojts.2012.24018.
[1]   N. K. Altorki, M. Sunagawa and D. B. Skinner, “Thoracic Oesophageal Diverticula. Why Is Operation Necessary?” The Journal of Thoracic and Cardiovascular Surgery, Vol. 105, No. 2, 1993, pp. 260-264.

[2]   R. Rosati, U. Fumagalli, S. Bona, L. Bonavina and A. Peracchia, “Diverticulectomy, Myotomy, and Fundoplication through Laparoscopy: A New Option to Treat Epiphrenic Esophageal Diverticula?” Annals of Surgery, Vol. 227, No. 2, 1998, pp. 174-178. doi:10.1097/00000658-199802000-00004

[3]   J. C. Benacci, C. Deschamps, V. F. Trastek, M. S. Allen, R. C. Daly and P. C. Pairolero, “Epiphrenic Diverticulum: Results of Surgical Treatment,” The Annals of Thoracic Surgery, Vol. 55, No. 5, 1993, pp. 1109-1113. doi:10.1016/0003-4975(93)90016-B

[4]   E. Avisar and J. D. Luketich, “Adenocarcinoma in a Mid-Esophageal Diverticulum,” The Annals of Thoracic Surgery, Vol. 69, No. 1, 2000, pp. 288-289. doi:10.1016/S0003-4975(99)01201-1

[5]   M. Migliore and M. Signorelli, “Episodic Abdominal and Chest Pain in a Young Adult,” JAMA, Vol. 307, No. 16, 2012, pp. 1746-1747. doi:10.1001/jama.2012.506

[6]   S. C. Clark, S. A. Norton, K. Jeyasingham and P. D. Ridley, “Oesophageal Epiphrenic Diverticulum: An Unusual Presentation and Review,” Annals of the Royal College of Surgeons of England, Vol. 77, No. 5, 1995, pp. 342-345.

[7]   M. Migliore, H. Payne and K. Jeyasingham, “Pathophysiologic Basis for Operation of Zenker’s Diverticulum,” The Annals of Thoracic Surgery, Vol. 57, No. 6, 1994, pp. 1616-1620. doi:10.1016/0003-4975(94)90134-1

[8]   M. Migliore, “The Upper Esophageal Sphincter and the Cricoesophageal Coordination,” Annali Italiani di Chirurgia, 2012, in Press.

[9]   P. M. Fisichella, M. Pittman and P. C. Kuo, “Laparoscopic Treatment of Epiphrenic Diverticula: Preoperative Evaluation and Surgical Technique. How I Do It,” Journal of Gastrointestinal Surgery, Vol. 15, No. 10, 2011, pp. 1866-1871. doi:10.1007/s11605-011-1631-6

[10]   M. Migliore, M. Arcerito, A. Vagliasindi, R. Puleo, F. Basile and G. Deodato, “The Place of Belsey Mark IV Fundoplication in the Era of Laparoscopic Surgery,” European Journal of Cardiothoracic Surgery, Vol. 24, No. 4, 2003, pp. 625-630. doi:10.1016/S1010-7940(03)00445-7

[11]   M. Migliore and K. Jeyasingham, “Re-Operations for Failed Anti-Reflux Surgery. Lessons from the Past and Prospects for the Future,” Annali Italiani di Chirurgia, Vol. 80, No. 4, 2009, pp. 267-274.

[12]   M. Migliore, “Reoperation for Failed Antireflux Surgery,” Multimedia Manual of Cardio-Thoracic Surgery, Vol. 2011, No. 0311, 2011. doi:10.1510/mmcts.2009.004226

[13]   M. L. Thomas, A. A. Anthony, B. G. Fosh, J. G. Finch and G. J. Maddern, “Oesophageal Diverticula,” British Journal of Surgery, Vol. 88, No. 5, 2001, pp. 629-642. doi:10.1046/j.1365-2168.2001.01733.x

[14]   X. B. D’Journo, P. Ferraro, J. Martin, L. Q. Chen and A. Duranceau, “Lower Oesophageal Sphincter Dysfunction Is Part of the Functional Abnormality in Epiphrenic Diverticulum,” British Journal of Surgery, Vol. 96, No. 8, 2009, pp. 892-900. doi:10.1002/bjs.6652