ABSTRACT
BACKGROUND: Esophageal intramural pseudodiverticulosis is an uncommon, idiopathic disorder characterized by multiple small outpouchings protruding from the esophageal lumen. Esophageal intramural pseudodiverticulosis is associated with conditions such as gastroesophageal reflux disease and diabetes mellitus, as well as emergent complications including pneumomediastinum. The most common presenting symptom is dysphagia with associated esophageal stricture formation. While the pathogenesis of EIP has yet to be determined, it is important to bring awareness to this unique disease with distinctive diagnostic findings and treatment options. CASE PRESENTATION: In this case, we present a 62-year-old woman who suffered from dysphagia, an inability to tolerate a regular diet, and unintentional weight loss for several years prior to her diagnoses. She was diagnosed by esophagram and esophagogastroduodenoscopy to have esophageal intramural pseudodiverticulosis, complicated by severe stricture formation. Following treatment with sequential dilatation and maintenance H2-blocker therapy, she achieved significant symptomatic improvement. CONCLUSIONS: This case highlights the importance of accurate identification and treatment of an uncommon cause of dysphagia, esophageal intramural pseudodiverticulosis. Treatment includes dilatational therapy, as successfully demonstrated in our patient. Furthermore, treatment is focused on optimizing medical management, as demonstrated in our patient with the addition of an H2-blocker for GERD, or addressing potentially serious underlying causes, such as carcinoma, with surgery.
Subject(s)
Deglutition Disorders/etiology , Diverticulosis, Esophageal/diagnostic imaging , Deglutition Disorders/therapy , Dilatation , Diverticulosis, Esophageal/complications , Diverticulosis, Esophageal/therapy , Endoscopy, Digestive System , Esophageal Stenosis/complications , Esophageal Stenosis/diagnostic imaging , Esophageal Stenosis/therapy , Esophagoscopy , Female , Histamine H2 Antagonists/therapeutic use , Humans , Middle AgedSubject(s)
Bronchial Fistula/etiology , Diverticulosis, Esophageal/complications , Esophageal Diseases/pathology , Esophageal Fistula/etiology , Aged , Bronchial Fistula/diagnostic imaging , Bronchoscopy/methods , Deglutition Disorders/diagnosis , Deglutition Disorders/etiology , Dilatation/adverse effects , Diverticulosis, Esophageal/pathology , Esophageal Fistula/diagnostic imaging , Gastrostomy/methods , Humans , Jejunostomy/methods , Male , Stents/adverse effects , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Esophageal intramural pseudodiverticulosis is an uncommon esophageal benign disease. The typical finding during endoscopy is the presence of numerous pinhead-sized outpouchings along the esophageal wall. We reported a case of food bolus impaction secondary to esophageal intramural pseudodiverticulosis. A 67-year-old man presented with sudden-onset dysphagia. Multiple tiny orifices were revealed during upper endoscopy. In addition, there were an impacted food bolus and an esophageal web. The patient was treated with balloon dilatation and proton pump inhibitors. As a result the symptoms disappeared completely. Esophageal intramural pseudodiverticulosis is a rare cause of food bolus impaction and its treatment is directed towards the underlying associated conditions as well as the resolution of complications.
La pseudodiverticulosis intramural esofágica es una enfermedad benigna del esófago poco común. El hallazgo típico durante la endoscopia es la presencia de numerosos sáculos del tamaño de una cabeza de alfiler a lo largo de la pared esofágica. Reportamos un caso de impactación de bolo alimentario secundario a pseudodiverticulosis esofágica intramural. Un hombre de 67 años presentó disfagia de aparición repentina. Se encontraron múltiples orificios pequeños en la endoscopia superior. Además, hubo un bolo alimentario impactado y una red esofágica. El paciente fue tratado con dilatación con balón e inhibidores de la bomba de protones. Como resultado, los síntomas desaparecieron por completo. La pseudodiverticulosis intramural esofágica es una causa rara de impactación del bolo alimentario y su tratamiento se dirige a las condiciones asociadas subyacentes, así como a la resolución de complicaciones.
Subject(s)
Aged , Humans , Male , Deglutition Disorders/etiology , Diverticulosis, Esophageal/complications , Food , Deglutition Disorders/therapy , Gastric Balloon , Esophagoscopy , Diverticulosis, Esophageal/therapy , Diverticulosis, Esophageal/diagnostic imaging , Dilatation/instrumentation , Dilatation/methodsSubject(s)
Diverticulosis, Esophageal/complications , Diverticulosis, Esophageal/diagnostic imaging , Esophageal Stenosis/complications , Esophageal Stenosis/diagnostic imaging , Esophagus/diagnostic imaging , Esophagus/pathology , Aged , Barium , Diverticulosis, Esophageal/drug therapy , Endosonography , Esophageal Stenosis/drug therapy , Esophagoscopy , Humans , Male , Proton Pump Inhibitors/therapeutic use , Treatment OutcomeABSTRACT
Esophageal intramural pseudodiverticulosis is an uncommon esophageal benign disease. The typical finding during endoscopy is the presence of numerous pinhead-sized outpouchings along the esophageal wall. We reported a case of food bolus impaction secondary to esophageal intramural pseudodiverticulosis. A 67-year-old man presented with sudden-onset dysphagia. Multiple tiny orifices were revealed during upper endoscopy. In addition, there were an impacted food bolus and an esophageal web. The patient was treated with balloon dilatation and proton pump inhibitors. As a result the symptoms disappeared completely. Esophageal intramural pseudodiverticulosis is a rare cause of food bolus impaction and its treatment is directed towards the underlying associated conditions as well as the resolution of complications.
Subject(s)
Deglutition Disorders/etiology , Diverticulosis, Esophageal/complications , Food , Aged , Deglutition Disorders/therapy , Dilatation/instrumentation , Dilatation/methods , Diverticulosis, Esophageal/diagnostic imaging , Diverticulosis, Esophageal/therapy , Esophagoscopy , Gastric Balloon , Humans , MaleABSTRACT
Dysphagia is a common complaint of patients seen at the outpatient clinic as well as at the emergency room. We report esophageal intramural pseudodiverticulosis (EIPD) as a cause of dysphagia that is less known by physicians and it is rarely described in the literature. EIPD is characterized by multiple, segmental or diffuse, flask-like outpouchings in the esophageal wall corresponding to dilated and inflamed excretory ducts of the submucosal esophageal glands. The underlying etiology remains unclear. Esophageal strictures, esophageal candidiasis and gastroesophageal reflux disease are often associated. The diagnosis can be made by upper gastrointestinal endoscopy, but barium esophagography is the modality of choice. Complications of EIPD are rare and include broncho-esophageal and esophagomediastinal fistula, pleural and pericardial effusion, abscesses, gastrointestinal bleeding from a web-like stenosis or esophageal perforation with pneumomediastinum. The treatment for EIPD should be directed towards treating underlying associated conditions and relieving symptoms rather than the pseudodiverticulosis itself.
Subject(s)
Diverticulosis, Esophageal/diagnosis , Esophageal Perforation/diagnostic imaging , Esophageal Stenosis/diagnostic imaging , Mediastinal Emphysema/diagnostic imaging , Deglutition Disorders/etiology , Diverticulosis, Esophageal/complications , Endoscopy, Digestive System , Esophageal Diseases/complications , Esophageal Diseases/diagnosis , Esophageal Perforation/complications , Esophageal Stenosis/complications , Humans , Male , Mediastinal Emphysema/etiology , Middle Aged , Tomography, X-Ray ComputedABSTRACT
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.
Subject(s)
Aorta, Thoracic/abnormalities , Deglutition Disorders/surgery , Diverticulosis, Esophageal/surgery , Esophagus , Aorta, Thoracic/surgery , Cardiopulmonary Bypass/methods , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Deglutition Disorders/etiology , Diverticulosis, Esophageal/complications , Diverticulosis, Esophageal/diagnostic imaging , Esophagus/diagnostic imaging , Female , Humans , Middle Aged , Thoracotomy , Tomography, X-Ray ComputedSubject(s)
Deglutition Disorders/etiology , Diverticulosis, Esophageal , Esophageal Stenosis/etiology , Esophageal Stenosis/therapy , Alcohol Drinking/adverse effects , Anti-Ulcer Agents/administration & dosage , Carbon Dioxide/administration & dosage , Constriction, Pathologic , Diverticulosis, Esophageal/complications , Esomeprazole/administration & dosage , Esophageal Stenosis/diagnostic imaging , Esophagoscopy , Humans , Insufflation/methods , Male , Middle Aged , Risk Factors , Smoking/adverse effects , Treatment OutcomeABSTRACT
We present the rare case of a proximal oesophageal stricture caused by a combination of oesophageal lichen planus without any other manifestations and intramural pseudo-diverticulosis, resulting in significant dysphagia. The diagnosis was not reached until a second set of biopsies were performed after split-dose treatment with proton pump inhibitors. Although local corticosteroid treatment was unsuccessful and symptomatic relief was only achieved after endoscopic dilatation, this case emphasizes the importance of adequate biopsies in the diagnosis of oesophageal strictures.
Subject(s)
Diverticulosis, Esophageal/complications , Esophageal Stenosis/etiology , Lichen Planus/complications , Aged , Deglutition Disorders/etiology , Deglutition Disorders/surgery , Endoscopy , Esophageal Stenosis/surgery , Humans , Lichen Planus/pathology , MaleABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Diverticulosis, Esophageal/complications , Diverticulosis, Esophageal/physiopathology , Diverticulosis, Esophageal , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/diagnosis , Dyspnea/complications , Dyspnea/etiology , Dyspnea , Vital Capacity/physiology , Vital Capacity/radiation effects , Forced Expiratory Volume/physiology , Esophagus/pathology , EsophagusSubject(s)
Deglutition Disorders/etiology , Diverticulosis, Esophageal/complications , Humans , Male , Middle AgedSubject(s)
Diverticulosis, Esophageal/complications , Drainage , Esophagoscopy , Intubation, Gastrointestinal/methods , Negative-Pressure Wound Therapy/methods , Adult , Drainage/instrumentation , Drainage/methods , Enteral Nutrition/methods , Esophageal Perforation/diagnosis , Esophageal Perforation/etiology , Esophageal Perforation/physiopathology , Esophageal Perforation/therapy , Esophagoscopy/instrumentation , Esophagoscopy/methods , Female , Humans , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
We here report a rare case of esophageal intramural pseudodiverticulosis with dysphagia. A 65-year-old man was suffering from intermittent dysphagia for 10 years, which had been worsening in recent months. Endoscopic examination revealed multiple, small, saccular diverticula and mild annular stricture with numerous white plaques from the cervical esophagus to the middle thoracic esophagus. Barium esophagography revealed stricture of the upper thoracic esophagus with multiple tiny flask-shaped outpouchings. Based on this characteristic appearance, we diagnosed esophageal intramural pseudodiverticulosis and inflammation of a narrow segment of the esophagus. Biopsy specimen showed acute and chronic esophagitis with Candida infection. Dysphagia persisted despite resolution of candidiasis, for which we successfully performed endoscopic balloon dilatation of the stricture. After the treatment, the patient has been well and has not been suffering from dysphagia.
Subject(s)
Dilatation/methods , Diverticulosis, Esophageal/therapy , Endoscopy, Digestive System/methods , Aged , Candidiasis , Chronic Disease , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Disease Progression , Diverticulosis, Esophageal/complications , Diverticulosis, Esophageal/diagnosis , Esophageal Stenosis/etiology , Esophageal Stenosis/therapy , Esophagitis/complications , Esophagitis/diagnosis , Esophagitis/microbiology , Esophagitis/pathology , Humans , Male , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Diverticulosis, Esophageal/complications , Diverticulosis, Esophageal/diagnosis , Diverticulosis, Esophageal/surgery , Deglutition Disorders/complications , Deglutition Disorders/etiology , Deglutition Disorders , Gastroscopy/methods , Gastroscopy/trends , Diverticulosis, Esophageal/physiopathology , Diverticulosis, Esophageal , Deglutition Disorders/physiopathology , Manometry/methods , ManometryABSTRACT
UNLABELLED: Esophageal intramural pseudodiverticulosis (EIPD) is a rare disorder in adults, and even more in infants and children. It is characterized by the dilatation of the submucosal esophageal glands. The exact etiology and pathophysiology of EIPD is, however, unknown. Dysphagia is the predominant presenting symptom in both children and adults. CONCLUSION: Here, we present a case of a boy with persistent dysphagia who had a thorough diagnostic workup and was eventually diagnosed with EIPD.