Epiphrenic diverticulum. (Esophagoscopy Clinic).A 51-year-old woman came to our center with a 30-year history of hoarseness, chronic cough, breathing difficulties, and heartburn. She was diagnosed with gastroesophageal and pharyngeal reflux disease and treated with an [H.sub.2] blocker and a proton-pump inhibitor. Despite therapy, 24-hour pH studies showed that significant reflux remained, and the patient subsequently underwent laparoscopic Laparoscopic A minimally-invasive surgical or diagnostic procedure that uses a flexible endoscope (laparoscope) to view and operate on structures in the abdomen. Mentioned in: Obstetrical Emergencies fundoplication. After surgery, the patient reported that her symptoms had been greatly relieved. However, 4 months postoperatively, she began to experience postprandial epigastric epigastric adjective Referring to the body region between the costal margins and the subcostal plane pain. She underwent transnasal esophagoscopy (TNE) as a component of her evaluation, and it revealed the presence of esophagitis esophagitis /esoph·a·gi·tis/ (e-sof?ah-ji´tis) inflammation of the esophagus. chronic peptic esophagitis reflux e. and a small diverticulum diverticulum Small pouch or sac formed in the wall of a major organ, usually the esophagus, small intestine, or large intestine (the most frequent site of problems). in the lower third of her esophagus (figure 1). Biopsy analysis revealed only chronic inflammation. The diverticulum was also demonstrated on barium esophagography (figure 2). Diverticula diverticula /di·ver·tic·u·la/ (di?ver-tik´u-lah) [L.] plural of diverticulum. Diverticula A diverticulum of the colon is a sac or pouch in the colon walls which is usually asymptomatic (without of the esophagus can be classified into two categories:pulsion and traction. Pulsion diverticula arise as a result of an increase in pressure gradient, which leads to a herniation herniation /her·ni·a·tion/ (her?ne-a´shun) abnormal protrusion of an organ or other body structure through a defect or natural opening in a covering, membrane, muscle, or bone. of the mucosa through a weak point in the esophageal muscle layer. Pulsion diverticula can be located in the hypopharynx (Zenker' s diverticulum) or in the lower third of the esophagus (epiphrenic diverticulum). Traction diverticula occur as a result of inflammatory reactions in neighboring lymph nodes or as a result of an embryonic malformation; they are made up of all layers of the esophageal wall. Epiphrenic diverticula are uncommon. They are probably caused by a stricture or by a long-standing impairment of esophageal motor activity. Although some patients are asymptomatic and their diverticula are detected incidentally, most patients are symptomatic. Symptoms such as abdominal pain and dysphagia are common. However, symptoms are often nonspecific and might be the result of an associated esophageal motility disorder An esophageal motility disorder is a medical disorder causing difficulty in swallowing, regurgitation of food and a spasm-type pain which can be brought on by an allergic reaction to certain foods. See also
From the Center for Voice Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org |
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