Epiphrenic diverticulum

Epiphrenic diverticula are pulsion diverticula of the distal oesophagus arising just above the lower oesophageal sphincter, more frequently on the right posterolateral wall.

They are less frequent than traction mid oesophageal diverticula, but may have more clinical relevance.  

Clinical presentation

Epiphrenic diverticula may present with symptoms of dysphagia, and regurgitation. When large they can cause distal oesophageal compression.

Pathology

These are considered to be pulsion type diverticula, thought to arise due to increased intraluminal pressure and hence the strong association with oesophageal dysmotility.

The diverticulum forms as the submucosa and mucosa herniate focally through the muscularis propria. Since the diverticular wall lacks the muscular layer, it is classified as a "false" diverticulum.

Associations

They are associated with:

Radiographic features

Plain radiograph

On chest X-ray, they may appear as a retrocardiac soft tissue mass with or without an air-fluid level, mimicking a hiatus hernia.

Fluoroscopy

Best imaging method is a single contrast oesophagogram, including prone RAO oblique views of the distal oesophagus. 

  • determine the relationship between the diverticulum and the gastro-oesophageal junction
  • look for evidence of oesophageal motility disorders and hiatus hernia.  

Treatment and prognosis

Epiphrenic diverticula can be treated surgically with myomectomy or diverticulectomy.

Differential diagnosis


Oesophageal pathology
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Article Information

rID: 20707
Section: Pathology
Synonyms or Alternate Spellings:
  • Epiphrenic oesophageal diverticulum
  • Epiphrenic diverticula
  • Epiphrenic oesophageal diverticula

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