Pulsion oesophageal diverticulum

Case contributed by Dr Jose Ignacio Aragon

Presentation

Dysphagia of 1 year.

Patient Data

Age: 68
Gender: Male
Fluoroscopy

Esophagogram shows the presence of rounded contour outpouchings in the midesophagus in relation with Pulsion diverticula. Both diverticulums showed rounded contour and wide necks.And, both remain filled after most of the barium has emptied from the esophagus by peristalsis.

Proximally and distally to the diverticulum there are areas with evidence of esophageal dismotility.

Case Discussion

Oesophageal diverticula is an outpouching projecting from the oesophagus. Diverticula may be classified by their location or by their mechanism of formation.

By location:

  • pharyngoesophageal junction (upper esophagus), i.e. Zenker's diverticulum.
  • midesophagus.
  • distal oesophagus just above the gastroesophageal junction, i.e. epyphrenic diverticulum.

By mechanism of formation:

  • pulsion diverticulum develops as a result of increased intraluminal esophageal pressure from underlying esophageal dysmotility. Frequently multiple.
  •  traction diverticulum develops because of fibrosis in adjacent peri-oesophageal tissues.

Usually, they are incidental findings in asymptomatic patients.

Findings

Oesohagogram: barium filled outpouchings projecting from the esophagus, best seen in profile.

Pulsion diverticula:  Most common, usually located in the middle or distal third of the esophagus, often associated with motility disorder. They appear as outpouching with rounded contour and a wide neck. "False diverticulum".

Traction diverticula: usually have a triangular configuration as a result of scarring and retraction (surgery, radiation, or granulomatous disease affecting the adyacent mediastinum). They tend to occur as solitary outpouchings containing all of the esophageal wall layers. They tend to empty when the esophagus collapses (muscular layer of the esophageal wall). "True diverticulum"

Case courtesy: Dr Jose R Zuniga.

 

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Case information

rID: 44506
Case created: 25th Apr 2016
Last edited: 14th Aug 2016
Inclusion in quiz mode: Included

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