Rad-5. Esophageal diverticula: current classification and important complications.

Esophageal diverticula are often asymptomatic or discovered incidentally during the workup of unrelated symptoms. They may serve as a sign of an ongoing dysmotility process involving the esophagus, particularly in our aging population. Esophageal diverticula may lead to unexpected complications as a result of instrumentation that may result in significant morbidity and mortality. The etiology, classification, radiologic appearance, diagnosis, and complications of esophageal diverticula are discussed and demonstrated. Most esophageal diverticula are formed by either pulsion or traction. Most midesophageal diverticula are secondary to esophageal dysmotility. Lower esophageal diverticula are formed by a pulsion mechanism that occurs from increased pressure during esophageal contractions. It is more specific to classify diverticula by methods of formation than by location within the esophagus. The diverticulum appears as a well circumscribed outpouching with smooth, regular outlines. Barium radiography is the diagnostic procedure of choice. Complications include obstruction, perforation, infection, ulceration, bezoar formation, GI bleeding, cardiac arrhythmias, and fistula formation. Knowledge and documentation of the presence of an esophageal diverticulum is important for prompt recognition and treatment of complications, and for consideration of inherent risks of seemingly unrelated diagnostic and therapeutic procedures.

Kathryn M. Nutter, MD, Ottis G. Ball, MD, W. Mel Flowers, Jr, MD, Philip E. Cranston, MD, and Robert D. Halpert, MD. Department of Radiology, University of Mississippi Medical Center, Jackson, MS.