Vol. 3 No. 2 (2020): Open Journal of Gastroenterology and Hepatology
Research Articles

EPIPHRENIC OESOPHAGEAL DIVERTICULUM – A CASE REPORT

Oguntoye Oluwatosin Oluwagbenga1, Yusuf Musah1, Olowoyo Paul1, Erinomo Olagoke2, Omoseebi Oladipo2, Soje Michael Osisiogu1, Oguntoye Oluwafunmilayo Adenike3, Fatudimu Oluwafemi4
1Department of Internal Medicine, Federal Teaching Hospital Ido-Ekiti and Afe Babalola University Ado-Ekiti, Nigeria; 2Department of Morbid Anatomy, Federal Teaching Hospital Ido-Ekiti and Afe Babalola University Ado-Ekiti, Nigeria; 3Department of Internal Medicine, Federal Teaching Hospital Ido-Ekiti, Nigeria;4Department of Surgery, Federal Teaching Hospital Ido-Ekiti, Nigeria.
Keywords
  • Epiphrenic, Oesophagus, Diverticulum.
How to Cite
Oguntoye Oluwatosin Oluwagbenga1, Yusuf Musah1, Olowoyo Paul1, Erinomo Olagoke2, Omoseebi Oladipo2, Soje Michael Osisiogu1, Oguntoye Oluwafunmilayo Adenike3, Fatudimu Oluwafemi4. (2020). EPIPHRENIC OESOPHAGEAL DIVERTICULUM – A CASE REPORT. Open Journal of Gastroenterology and Hepatology, 3(2), 34. https://doi.org/10.28933/ojgh-2020-02-2305

Abstract

Epiphrenic oesophageal diverticulum is rare world-wide and account for less than 10% of all oesophageal diverticula. We present Mrs O.E. a 64-year old Nigerian of the Yoruba tribe who presented with early satiety and upper abdominal discomfort of five months duration. The early satiety was of insidious onset and had been progressive. This initially made her to reduce the size of her meal intake but eventually progressively led her to taking just a meal per day. This is in contrast with her premorbid intake of three meals per day. She has associated history of regurgitation worse in the recumbent position which she described as containing undigested food. She has no abdominal swelling, odynophagia or dysphagia. No history of haematemesis or melaena. She has weight loss and easy fatigability. The upper abdominal (epigastric) discomfort is characterized as a feeling of peppery, burning sensation which radiates to the back and had no association with meals or with time of the day. It has no relation to posture and said to be worse with consumption of peppery or spicy food substance. Minimally relieved with the use of antacids. No other significant contributory history. Review of systems was also not contributory. Clinical examination was not remarkable. A provisional diagnosis of a suspected Gastric Tumour was made likely a Gastric Lymphoma or Adenocarcinoma to rule out Gastrointestinal Stromal Tumour(GIST). Barium swallow revealed a Distal (Epiphrenic) oesophageal diverticulum. Findings at upper GI Endoscopy include: (1) Distal (Epiphrenic) oesophageal diverticulum (2) Reflux oesophagitis (3) Gastric Atrophy; probably age-related to rule out chronic Helicobacter pylori-infection. Histology revealed Reflux oesophagitis, Mildly active chronic corporeal gastritis with mild atrophy and Chronic non-specific antral gastritis. She was managed conservatively with long term proton pump inhibitor therapy, modification of dietary habits and liberal oral fluid intake with significant clinical improvement and resolution of her symptoms within eight weeks of treatment. She is presently on regular follow-up at our out-patient department. Distal (Epiphrenic) oesophageal diverticulum is rare in our environment. The diagnosis can only be made through radiographic or endoscopic studies. Patients may present with non-specific or dyspeptic symptoms similar to those of acid peptic disorders. In view of this, it is important to carefully evaluate patients with dyspepsia or non-specific upper gastrointestinal symptoms and investigate them in order to ascertain the cause. A delay in the diagnosis and treatment of epiphrenic oesophageal diverticulum may lead to complications which could have been prevented if diagnosed early.

References

  1. Matthews, B.D; Nelms, C.D; Lohr, C.E; Harold, K.L; Kercher, K.W; Heniford, B.T. Minimally invasive management of epiphrenic esophageal diverticula. Am Surg. 2003, 69:465-470.
  2. Nehra, D; Lord, R.V; DeMeester, T.R. et al. Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg. 2002, 235:346 -354. Abstract
  3. Melman, L; Quinlan, J; Robertson, B. et al. Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc. 2009, 23:1337-1341.
  4. Klaus, A; Hinder, R.A; Swain, J; Achem, S.R. Management of epiphrenic diverticula. J Gastrointest Surg. 2003, 7:906-911.
  5. Herbella, F.A; Patti, M.G. Modern pathophysiology and treatment of esophageal diverticula. Langenbecks Arch Surg. 2012, 397:29–35.
  6. Magee, M.J; Sonett, J.R. Management of epiphrenic esophageal diverticula. Oper Tech Thorac Cardiovasc Surg. 2011, 16:18–29.
  7. Plackett, T.P; Meghoo, C.A; Febinger, D.L. Recurrent epiphrenic diverticulum after transabdominal diverticulectomy: Report of a case and review of the literature. Image, 2009, 68:13–5.
  8. Zaninotto, G; Portale, G; Costantini, M; Zanatta, L; Salvador, R; Ruol, A. Therapeutic strategies for epiphrenic diverticula: Systematic review. World J Surg. 2011, 35:1447–53.
  9. Conklin, J.H; Singh, D; Katlic, M.R. Epiphrenic esophageal diverticula: Spectrum of symptoms and consequences. J Am Osteopath Assoc. 2009, 109:543–5.
  10. Fasano, N.C; Levine, M.S; Rubesin, S.E; Redfern, R.O; Laufer, I. Epiphrenic diverticulum: clinical and radiographic findings in 27 patients. Dysphagia, 2003, 18:9-15.
  11. Honda, H; Kume, K; Tashiro, M; Sugihara, Y; Yamasaki, T; Narita, R. et al. Early stage esophageal carcinoma in an epiphrenic diverticulum. Gastrointest Endosc. 2003, 57:980-982.
  12. Song, Y.C; Zhang, Y.D; Wang, Q.Z; Yan, J.S; Du, X.Q; Zhang, M.G. et al. Carcinoma in the esophageal diverticulum. Chin Med J (Engl). 1985, 98:895-898.