Iberoamerican Journal of Medicine
https://iberoamjmed.com/article/doi/10.53986/ibjm.2022.0014
Iberoamerican Journal of Medicine
Case Report

Giant Epiphrenic Diverticulum: A Challenging Case

Divertículo epifrénico gigante: un caso desafiante

Rasul Uzdenov, Sukhrob Atakhadzhaev, Muhammad Asim, Serghei Covantev

Downloads: 0
Views: 190

Abstract

A diverticulum is a limited saccular protrusion of the esophageal wall, communicating with its lumen. Anatomically, esophageal diverticula are classified into pharyngoesophageal, median, and epiphrenic. Treatment of esophageal diverticula is based on several basic pathophysiological principles. Small and asymptomatic diverticula do not require specific treatment. Large and symptomatic diverticula require surgical intervention, consisting of diverticulectomy combined with myotomy. Operations for symptomatic epiphrenic diverticula make up no more than 2% of all operations on the esophagus. We describe a case of an epiphrenic diverticulum with the dimensions 88x60x90 mm in a 54-year-old patient. Surgical treatment of this disease was performed according to the Lewis method. The article also describes methods of dealing with concomitant postoperative complications and a brief review of the literature on epiphrenic diverticula.

Keywords

Epiphrenic diverticula; Lewis operation; Eventration

Resumen

Un divertículo es una protuberancia sacular limitada de la pared esofágica, que se comunica con su luz. Anatómicamente, los divertículos esofágicos se clasifican en faringoesofágicos, medianos y epifrénicos. El tratamiento de los divertículos esofágicos se basa en varios principios fisiopatológicos básicos. Los divertículos pequeños y asintomáticos no requieren tratamiento específico. Los divertículos grandes y sintomáticos requieren intervención quirúrgica, que consiste en diverticulectomía combinada con miotomía. Las operaciones por divertículos epifrénicos sintomáticos representan no más del 2% de todas las operaciones en el esófago. Describimos un caso de divertículo epifrénico de dimensiones 88x60x90 mm en un paciente de 54 años. El tratamiento quirúrgico de esta enfermedad se realizó según el método de Lewis. El artículo también describe métodos para tratar las complicaciones posoperatorias concomitantes y una breve revisión de la literatura sobre divertículos epifrénicos.

Palabras clave

Divertículo epifrénico; Operación de Lewis; Eventración

References

1. Thomas ML, Anthony AA, Fosh BG, Finch JG, Maddern GJ. Oesophageal diverticula. Br J Surg. 2001;88(5):629-42. doi: 10.1046/j.1365-2168.2001.01733.x.
2. Wheeler D. Diverticula of the foregut. Radiology. 1947;49(4):476-82. doi: 10.1148/49.4.476.
3. Dobashi Y, Goseki N, Inutake Y, Kawano T, Endou M, Nemoto T. Giant epiphrenic diverticulum with achalasia occurring 20 years after Heller's operation. J Gastroenterol. 1996;31(6):844-7. doi: 10.1007/BF02358612.
4. Beiša V, Kvietkauskas M, Beiša A, Strupas K. Laparoscopic approach in the treatment of large epiphrenic esophageal diverticulum. Wideochir Inne Tech Maloinwazyjne. 2016;10(4):584-8. doi: 10.5114/wiitm.2015.56407.
5. Andolfi C, Wiesel O, Fisichella PM. Surgical Treatment of Epiphrenic Diverticulum: Technique and Controversies. J Laparoendosc Adv Surg Tech A. 2016;26(11):905-10. doi: 10.1089/lap.2016.0365.
6. Borrie J, Wilson RL. Oesophageal diverticula: principles of management and appraisal of classification. Thorax. 1980;35(10):759-67. doi: 10.1136/thx.35.10.759.
7. Tapias LF, Morse CR, Mathisen DJ, Gaissert HA, Wright CD, Allan JS, et al. Surgical Management of Esophageal Epiphrenic Diverticula: A
Transthoracic Approach Over Four Decades. Ann Thorac Surg. 2017;104(4):1123-30. doi: 10.1016/j.athoracsur.2017.06.017.
8. Hegazy A. Clinical embryology for medical students and postgraduate doctors. Lap Lambert Academic Publishing; 2014.
9. Yam J, Baldwin D, Ahmad SA. Esophageal Diverticula. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
10. Reznik SI, Rice TW, Murthy SC, Mason DP, Apperson-Hansen C, Blackstone EH. Assessment of a pathophysiology-directed treatment for symptomatic epiphrenic diverticulum. Dis Esophagus. 2007;20(4):320-7. doi: 10.1111/j.1442-2050.2007.00716.x.
11. Varghese TK Jr, Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula: a 30-year experience. Ann Thorac Surg. 2007;84(6):1801-9; discussion 1801-9. doi: 10.1016/j.athoracsur.2007.06.057.
12. Polynskiy AA, Chernyshov TM. [Eventration. Principles of diagnosis and medical treatment]. Grodno State Medical University Journal. 2014;2:10-4.
13. Shabunin AV, Bedin VV, Yakomaskin VN, Grekov DN, Covantev S. Clinical Case of a Gastric Diverticulum Operated by Laparoscopic Approach. Online J Health Allied Sci. 2018;17(4):9.
14. Herbella FA, Patti MG. Modern pathophysiology and treatment of esophageal diverticula. Langenbecks Arch Surg. 2012;397(1):29-35. doi: 10.1007/s00423-011-0843-2.
15. Fisichella PM. Laparoscopic repair of epiphrenic diverticulum. Semin Thorac Cardiovasc Surg. 2012;24(3):223-8. doi: 10.1053/j.semtcvs.2012.10.002.
16. Rosati R, Fumagalli U, Elmore U, de Pascale S, Massaron S, Peracchia A. Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum. Am J Surg. 2011;201(1):132-5. doi: 10.1016/j.amjsurg.2010.03.016.
17. Benacci JC, Deschamps C, Trastek VF, Allen MS, Daly RC, Pairolero PC. Epiphrenic diverticulum: results of surgical treatment. Ann Thorac Surg. 1993;55(5):1109-13; discussion 1114. doi: 10.1016/0003-4975(93)90016-b.


Submitted date:
11/05/2021

Reviewed date:
02/27/2022

Accepted date:
03/10/2022

Publication date:
03/10/2022

6229ae2da95395560413fb03 iberoamericanjm Articles
Links & Downloads

Iberoam J Med

Share this page
Page Sections