DIVERTICULOS ESOFAGICOS PDF

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DIVERTÍCULOS ESOFÁGICOS (CARATERÍSTICAS (PROTRUSIÓN O ABOMBAMIENTO SACULAR: DIVERTÍCULOS ESOFÁGICOS. Carta científica. Divertículos esofágicos: una causa infrecuente de agudización en la enfermedad pulmonar obstructiva crónica. Esophageal diverticulum: A rare . Divertículos esofágicos | Resumen Introducción El esófago es un órgano cilíndrico muscular cuya función primordial es la propulsión hacia el estómago del.

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Epiphrenic and middle esophageal diverticula: A rare cause of esophageal dysphagia. Esophageal high resolution manometry findings.

Manejo quirúrgico de los divertículos esofágicos epifrénicos – Artículos – IntraMed

Hospital Universitario 12 de Octubre. Esophageal diverticula ED constitute a rare pathology, with a prevalence ranging between 0. According to its anatomical location it is classified as pharyngo-esophageal, middle esophageal and epiphrenics ED 3.

The pathophysiologic mechanism differs in diverticula caused by traction, due esofagico an inflammatory process involving the esophagus, or pulsion, associated with a concomitant motility disorder A year-old male, without relevant clinical antecedents, presented with progressive esophageal dysphagia in the last 3 months.

Two years earlier, he had presented an episode of food esocagicos. Barium esophagogram BE detected a saccular image well delineated of 9 cm, esofagicox a hydro-aero level, in the lower esophageal third Fig. The gastroscopy showed a dual lumen image large in size with semi-solid food content inside Fig.

A years-old male patient with no clinical antecedents was forwarded from ear-nose-throat department for pharyngo-laryngeal foreign body sensation to rule out GERD. The BE revealed the presence of a saccular image in the epiphrenic region Fig. Esofagics year-old male, with clinical antecedents of chronic hepatitis C and hiatal hernia, presenting with progressive esophageal dysphagia over the last 6 months associated with esofgicos episodes of food regurgitation and heartburn.

The BE identified a 3 cm saccular image, located in the last 10 cm of the esophagus and a sliding hiatal hernia Fig. Upper endoscopy confirmed the presence of a diverticulum containing food inside, located 30 cm from diverticulso incisors Fig.

A year-old woman, diagnosed with systemic lupus erythematosus SLEpresenting with progressive esophageal dysphagia over the last two months, with frequent episodes of food regurgitation and 10 kg weight loss. The thoracic CT showed esophageal lumen dilatation at the height of the carina, with a diameter of 5.

The EB detected a saccular image of 4. An upper endoscopy identified a large esophageal diverticulum located 25 cm from the incisors with food inside. The esophageal biopsies were consistent with amyloidosis AA. A year-old woman with chronic renal failure antecedents presented with progressive esophageal dysphagia to solids and liquids over two years and bronchoaspiration episodes.

EB detected tertiary contractile diverticlos in the lower esophagus and an ED in the inferior and right posterior side of 2.

A year-old woman with antecedents of total thyroidectomy for endothoracic multinodular goiter, pill induced esophagitis inED Fig. She presented with dysphagia, mainly to djverticulos that provoked her admission into hospital for bronchoaspiration on 3 occasions.

In the last admission we confirmed the ED located at 28 cm from the incisors by upper endoscopy Fig. Esofayicos six patients described underwent a high-resolution manometry HRM Manoscan; Given that identified a concomitant esophageal motor disorder EMD in all ddiverticulos. The manometric parameters for all of the patients are shown in table I ; the reference values used were the current Chicago classification 7.

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The patient in the first case presented hypercontractile contractions at the esophageal segments S2 and S3, being compatible with the manometric diagnosis of hypercontractile esophagus “jackhammer” type Fig. The HRM of the second patient showed a distal esophageal spasm, with involvement at the level of the S3 segment Fig. The patient in the 4th case had outflow obstruction of the esophagogastric junction EGJ with features of achalasia subtype III spastic of probable secondary origin Fig.

The patient in the 5th case had a hypercontractile “jackhammer” motor disorder as well, with high amplitude waves in the djverticulos S2 and particularly in S3 Fig.

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The 6th case patient, an EMD was observed consisting of outflow obstruction of the EGJ, as well as alteration in the contractile sequence in the anatomic area of the diverticulum where enlargement of the contraction was observed between segments S2-S3 Fig. The segment predominantly affected in the HRM, coincided with the location of the ED observed in the radiological and endoscopic studies in all cases. Following the completion of the HRM, five of the six patients were referred for assessment for surgical treatment.

The second and third case patients decided to continue a conservative management, after rejecting the option for surgical treatment due to the morbidity and mortality associated with it. The fourth case patient presented an episode of upper gastrointestinal bleeding. A large clot attached to the wall of the diverticulum was detected in the urgent gastroscopy.

This accelerated the decision for surgical treatment of the diverticulum, once the episode of bleeding had surpassed. However, in the days after the bleeding event, the patient developed aspiration pneumonia and finally died. The 5th case patient was treated surgically by performing thoracoscopic diverticulectomy and myotomy. The 6th case patient was treated with endoscopic injection of botulinum toxin at the level of the EGJ to solve the functional outflow obstruction.

This treatment esofaigcos considered the best option considering the advanced age of the patient, improving the symptoms. The majority of diverticula are asymptomatic and are incidentally diagnosed during the investigation of lesser related symptoms. Esofagios complications of ED, such as ulcers and bleeding, are infrequent 3.

In the case of epiphrenic diverticula it was considered the protrusion of the mucosa and submucosa was caused by the increase in the esophageal pressure secondary to a motor disorder 8.

In our series of patients with ED a motor disorder in the esophageal body or in the EGJ was detected in all of them. Esophageal manometry is the gold standard for the diagnosis of the EMD 3. For many years, the conventional water-perfused manometry was the tool available to diagnose such disorders.

Today, the implementation of the HRM with the topographic plots obtained allows a higher accuracy in evaluation of the EGJ 12 and detection of segmental peristaltic defects, often unnoticed in the conventional study, though it obtains topographic plots of all of the esophagus by using a esofagicod number of sensors 4, In this respect, in our series of cases, we found pressure alterations in the anatomic area of the diverticulum, and we also identified the subjacent EMD, mainly spastic or hypercontractile, as well as alterations in the relaxation of the EGJ.

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In conclusion, HRM clarifies the pathophysiology of the formation of the ED and can support the need to perform a myotomy added to the reconstructive surgical technique and its extension according to the EMD type and the affected esophageal segments as in the case of the 5th patient, in eaofagicos surgical diverticulectomy and myotomy esogagicos performed. Detection of subclinical disorders of the hypopharynx and larynx by gastrointestinal endoscopy.

Herbella F, Patty MG. Modern pathophysiology and treatment of esophageal diverticula. Costantini M, Zaninotto G, Rizzetto, et al. Best Pract Res Clin Gastroenterol ; High resolution manometry findings in patients with esophageal epiphrenic diverticula. Association of midoesophageal diverticula with oesophageal motor disorders. Oesophageal pouches and diverticula: S Afr J Surg ; Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography.

Neurogastroenterol Motil ;24 Supl. Results of divrrticulos treatment. Ann Thorac Surg ; Alkali ingestion predisposes to developing giant mid-esophageal pulsion diverticulum – A report of a medical rarity. Esophageal diverticula and cancer. Diverticula of the esophagus. Surg Clin North Am ; How useful is esophageal high resolution manometry in diagnosing gastroesophageal junction disruption: Causes affecting this disruption and its relationship with esofagicoe alterations and gastroesophageal reflux.

Rev Esp Enferm Dig ; Introduction Esophageal diverticula ED constitute a rare pathology, with a prevalence ranging between 0. Case report Case report 1 A year-old male, without relevant clinical antecedents, presented with progressive esophageal dysphagia in the last 3 months.

Case report 2 A years-old male patient with no clinical antecedents was forwarded from ear-nose-throat department for pharyngo-laryngeal foreign body sensation to esofagicoa out GERD. Case report 3 A year-old male, with clinical antecedents of chronic hepatitis C and hiatal hernia, presenting with progressive esophageal dysphagia over the last 6 months associated with occasional episodes of food regurgitation and heartburn.

Case report 4 A year-old woman, diagnosed with systemic lupus erythematosus SLEpresenting with progressive esophageal dysphagia over the last two months, with frequent episodes of food regurgitation and 10 kg weight loss.

Case report 5 A year-old woman with chronic renal failure antecedents presented with progressive esophageal dysphagia to solids and liquids over two years and bronchoaspiration episodes. Caso report 6 A year-old woman with antecedents of total thyroidectomy for endothoracic multinodular goiter, pill induced esophagitis inED Fig.

Discussion The majority of diverticula are asymptomatic and are incidentally diagnosed during the investigation of lesser related symptoms.