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Traction Diverticulum of the Esophagus
Esophagus Traction Diverticulum

Presentation

Our patient presented with acute symptoms of pain and vomiting and later developed dysphagia. [thoracicmedicine.org]

Perfect for radiologists who need a comprehensive reference while working on difficult cases, it presents a complete yet concise overview of imaging applications, findings, and interpretation in every anatomic area. [books.google.com]

Presenting symptoms of Epiphrenic esophageal diverticula depends on the underlying disease process and they mostly present with alarming symptoms. [omicsonline.org]

TEDs usually present with dysphagia or recurrent aspiration. We describe here a rare presentation of upper gastro-intestinal bleeding resulting from ulceration and fistulization of the TED. [springerplus.springeropen.com]

Giant cell formation is rare, but fused histiocytes are present. [acgcasereports.gi.org]

Entire Body System

  • Asymptomatic

    Most often, esophageal diverticula are found incidentally and asymptomatic. However, if the diverticula is large enough it may fill with food or fluids and compress the true lumen of the esophagus causing dysphagia. [med-ed.virginia.edu]

    Asymptomatic Mid-oesophageal diverticula are commonly asymptomatic because they are relatively small. Most of the esophageal diverticula are pulsion diverticula, which protrudes from a weak point of the esophageal musculature. [explainmedicine.com]

    Patients with small diverticula may be asymptomatic. [clinicalgate.com]

    SIGNS AND SYMPTOMS Mucosal injury may be asymptomatic or may manifest by dysphagia, odynophagia or chest pain. [clevelandclinicmeded.com]

    These are true diverticula and typically are small and asymptomatic. Associated complications include diverticulitis, perforation, bleeding, and fistula formation. [aibolita.com]

  • Inflammation

    Esophagitis pseudomembranosa, CLINIC (72213) Esophagitis pseudomembranosa, CLINIC (72214) Pseudomembranous inflammation, anastomosis, esophagus: Pseudomembranous inflammation, anastomosis, esophagus, CLINIC (72841) Pseudomembranous inflammation, anastomosis [atlases.muni.cz]

    Skin biopsy showing isolated and confluent granulomas associated with mixed inflammation. Giant cell formation is rare, but fused histiocytes are present. [acgcasereports.gi.org]

    […] diverticulum surgery method L cervical incision, vertical myotomy several cm on either side of base of diverticulum, remove or suspend diverticulum, leave drains Post-op cricopharyngeal myotomy Traction diverticulum true/false Cause of Traction diverticulum Inflammation [quizlet.com]

    Traction diverticula of the acquired type are found in association with contracted fibrotic lymph glands and the scar tissue of chronic granulomatous inflammation, often tuberculous in origin. [hon.ch]

    Fever, cough, pleuritic chest pain are common complains of aspiration pneumonia. [2] Presence of risk factors Patients with a history of tuberculosis can have traction diverticula, secondary to inflammation and scarring of the mediastinal lymph nodes. [explainmedicine.com]

  • Swelling

    CASE REPORT In 1942, 10 years prior to his last admission, a 41 year old foundry worker was admitted to this hospital because of shortness of breath and swelling of the legs. He was found to have FULL TEXT [annals.org]

    […] of the lateral side of the neck Zenker’s diverticulum which is not a true esophageal diverticulum can cause swelling and sensation of pressure over the lateral side of the neck. [explainmedicine.com]

    ZD is more symptomatic then EED as they cause localize swelling leading to pressure symptoms and compression like feeling [ 5 ]. [omicsonline.org]

  • Lymphadenopathy

    CT chest gives most complete delineation of the tuberculous mediastinal lymphadenopathy and the fistulous tract extending from the esophagus into the nodal mass. [thoracicmedicine.org]

    Computed tomography scan of the chest in 2012 after an asthma attack was concerning for bilateral pulmonary stellate opacities, pleural-based opacities, and mediastinal and hilar lymphadenopathy. [acgcasereports.gi.org]

    This is most commonly seen in the presence of mediastinal lymphadenopathy secondary to either infection (histoplasmosis, tuberculosis) or malignancy. [clinicaladvisor.com]

  • Surgical Procedure

    The technical key steps of the surgical procedure are presented in a step by step way: exposure of diverticulum, dissection of diverticulum, dividing the neck of the diverticulum. [websurg.com]

    Zenker’s diverticula may be treated by open surgical procedures or by transoral endoscopic techniques with rigid or flexible fiberoptic instruments. [clinicalgate.com]

    Surgical Treatment Zenkers- There are several different surgical procedures employed for treatment of Zenkers diverticula with the preferred option being concomitant diverticulectomy and cricopharyngeal myotomy. [clinicaladvisor.com]

Respiratoric

  • Cough

    Fever, cough, pleuritic chest pain are common complains of aspiration pneumonia. [2] Presence of risk factors Patients with a history of tuberculosis can have traction diverticula, secondary to inflammation and scarring of the mediastinal lymph nodes. [explainmedicine.com]

    These symptoms range from mild nocturnal cough to life-threatening massive aspiration. In this particular report we describe a rare case of TED presenting as a symptomatic upper gastrointestinal bleeding. [springerplus.springeropen.com]

    Reflux-induced vagal irritation leads to dry, irritating cough. [lecturio.com]

    Symptoms may include difficulty swallowing ( dysphagia ), chronic coughing, regurgitation, or bad breath (halitosis). [everydayhealth.com]

  • Pneumonia

    Esophagram for Patient 3, 76-year-old woman with repeated aspiration pneumonia as well as heartburn and dysphagia. Figure 3. Esophagram for Patient 3, 76-year-old woman with repeated aspiration pneumonia as well as heartburn and dysphagia. [jaoa.org]

    Typically, esophageal diverticula are nuisances that enlarge slowly over many years, gradually producing increasing symptoms, such as dysphagia, regurgitation and aspiration pneumonia, caused by breathing in regurgitated diverticula content. [my.clevelandclinic.org]

    Fever, cough, pleuritic chest pain are common complains of aspiration pneumonia. [2] Presence of risk factors Patients with a history of tuberculosis can have traction diverticula, secondary to inflammation and scarring of the mediastinal lymph nodes. [explainmedicine.com]

    […] wall; due to disordered cricopharyngeal motor dysfunction or weakness in esophageal wall at junction with pharynx; at junction between the pharynx and esophagus (known as the Killian triangle), may accumulate food, cause regurgitation or aspiration pneumonia [pathologyoutlines.com]

    South Med J 87: 1003-1004. [ Crossref ] Aouad MT, Berzina CE, Baraka AS (2000) Aspiration pneumonia after anesthesia in a patient with a Zenker diverticulum. [oatext.com]

Gastrointestinal

  • Dysphagia

    Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass. [med-ed.virginia.edu]

    Our patient presented with acute symptoms of pain and vomiting and later developed dysphagia. [thoracicmedicine.org]

    Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 2. Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 3. [jaoa.org]

    […] esophagus Cause of Zenker's diverticulum and pulsion diverticula ↑ pressure during swallowing Location of Zenker's diverticulum Between cricopharyngeus (UES) and thyropharyngeus portion of inferior pharyngeal constrictors SSx of Zenker's diverticulum Dysphagia [quizlet.com]

  • Regurgitation of Undigested Food

    Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass. [med-ed.virginia.edu]

    […] of undigested food, dysphagia Tx for Traction diverticulum Excision w 1° closure, palliative XRT if 2/2 invasive CA Location of epiphrenic diverticulum Cause of epiphrenic diverticulum SSx of epiphrenic diverticulum ASx, dysphagia, regurgitation Dx of [quizlet.com]

    Patients complain of regurgitation of undigested food in to the mouth. [explainmedicine.com]

    Usually true diverticulum Common site: the middle esophagus References: [1] [2] [5] [3] Clinical features Clinical presentation depends on diverticulum size and localization Dysphagia (most common) Regurgitation of undigested food Aspiration Coughing [amboss.com]

    Patients present with upper esophageal dysphagia, regurgitation of undigested food, aspiration, noisy deglutition, halitosis, and changes in voice. Mild-to-moderate weight loss is frequent. [gastrointestinalatlas.com]

  • Vomiting

    Our patient presented with acute symptoms of pain and vomiting and later developed dysphagia. [thoracicmedicine.org]

    Left: Incidental finding of multiple small diverticula in the upper third of the esophagus of a 47 year-old man underoing endoscopy for evaluation of nausea, vomiting and early satiety; his symptoms proved to be secondary to pyloric stenosis. [endoatlas.com]

    Thereafter food delay in esophagus, choking, salivation, belching and vomiting develop. If the stricture is located in the lower part of esophagus, the vomitis can be of putrefactive character. [intranet.tdmu.edu.ua]

    Contraindication : Vomiting must not be induced. Chemical burns are classified according to the degree of severity. [lecturio.com]

    Symptoms related to EED include chest pain, heartburn, vomiting, dysphagia, regurgitation and often lose weight in varying degrees. However, they can be completely asymptomatic and incidental findings, particularly in the small and shallow lesion. [omicsonline.org]

  • Odynophagia

    Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 2. Esophagram for Patient 2, 75-year-old woman with regurgitation, dysphagia, pain, and odynophagia. Figure 3. [jaoa.org]

    (eg: Zenker’s diverticulum) can cause dysphagia and odynophagia. [2] Regurgitation Patients complain of regurgitation of undigested food in to the mouth. [explainmedicine.com]

    SIGNS AND SYMPTOMS Mucosal injury may be asymptomatic or may manifest by dysphagia, odynophagia or chest pain. [clevelandclinicmeded.com]

    He denied any fevers, unintentional weight loss, hemoptysis, sore throat, odynophagia, shortness of breath, or wheezing. On examination he was hemodynamically stable. Chest exam revealed lower left lung crackles. [acgcasereports.gi.org]

    Esophagitis Symptoms of esophagitis Symptoms include dysphagia, odynophagia, and retrosternal pain. Infectious esophagitis A severe general disease can be accompanied by esophagitis. [lecturio.com]

  • Nausea

    Left: Incidental finding of multiple small diverticula in the upper third of the esophagus of a 47 year-old man underoing endoscopy for evaluation of nausea, vomiting and early satiety; his symptoms proved to be secondary to pyloric stenosis. [endoatlas.com]

    Sometimes observed nausea and vomiting. The perforation of diverticulum can be directed into pleural space, trachea, bronchus or pericardium. The clinical picture depends on the place of perforation. [intranet.tdmu.edu.ua]

Neurologic

  • Motor Disturbances

    disturbances • Lesions < 3 cm often require no treatment • Extreme symptomatic patients sometimes require surgical repair Docsity.com Miscellaneous Condition of the Esophagus • Mallory-Weiss syndrome – During the act of forceful emesis against a closed [docsity.com]

Workup

X-Ray

  • Esophageal Motility Disorder

    Traction diverticula of either the congenital or acquired variety are not usually accompanied by an esophageal motility disorder. [hon.ch]

    Epiphrenic diverticula occur just above the diaphragm and usually accompany a motility disorder ( achalasia, diffuse esophageal spasm ). [merckmanuals.com]

    Most are associated with an underlying esophageal motility disorder. [ctsnet.org]

    […] web 食道運動障害 esophageal motility disorder, motor disorders of the esophagus 食道炎 esophagitis アルカリ性逆流性食道炎 alkaline reflux esophagitis 逆流性食道炎 reflux esophagitis 腐食性食道炎 corrossive esophagitis 食道癌 carcinoma of the esophagus 食道胃接合部癌 cancer of esophagogastric [jsge.or.jp]

    An esophageal motility disorder was present in 22 patients (PD, 21 and TD, 1). Three patients with a PD had an esophageal stricture. [sages.org]

Treatment

Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances. [books.google.com]

Treatment mostly requires for the underlying disease condition like achalasia [ 8 ]. Treatment for EED includes oesophageal myotomy, diverticulectomy, and fundoplication [ 3 ]. [omicsonline.org]

Majority of the patients respond well to antitubercular treatment. Our patient was stable and hence he was started on four-drug antitubercular treatment, to which he responded very well. [thoracicmedicine.org]

TREATMENT AND OUTCOMES Symptomatic Zenker's diverticula can be treated by surgical excision. Newer treatments are applied endoscopically. [clevelandclinicmeded.com]

Occasionally, a specific treatment such as a diverticulectomy or diverticulopexy needs to be directed to the diverticulum. Preliminary treatment results from minimally invasive surgery, especially laparoscopy, have been promising. [link.springer.com]

Prognosis

[…] mid esophagus at level of tracheal bifurcation; becoming uncommon; previously mostly due to tuberculosis, mediastinal lymphadenitis and scarring; may be due to motor dysfunction, congenital or alkali ingestion ( Med Hypotheses 2004;62:931 ); better prognosis [pathologyoutlines.com]

Treatment and Prognosis Patients with small asymptomatic or minimally symptomatic diverticula can be followed, because progressive enlargement is uncommon. 2 Patients with large and symptomatic Zenker’s diverticula should be offered treatment. [clinicalgate.com]

Even in adenocarcinoma which is less sensitive to chemo and radiotherapy, combined treatment improves prognosis. [clevelandclinicmeded.com]

Prognosis and Patient Counseling. Both surgical and endoscopic modalities have high success rates for symptom improvement (>90%). Surgical intervention does have an associated perioperative mortality of approximately 1.8%. [clinicaladvisor.com]

Overall, prognosis is rather bad since the first noticeable symptom of the disease, dysphagia, is a late symptom already. At the time the diagnosis is made, for 95 % of the tumors, palliative treatment is the only treatment option left. [lecturio.com]

Etiology

Importance Diverticula of the thoracic esophagus are classified by their location and their etiology [2]. Traction diverticula typically arise in the mid esophagus. [mayoclinic.pure.elsevier.com]

The possibility of a secondary motor disorder in the etiology of the diverticulum must be considered in these circumstances. [hon.ch]

They are categorized primarily by anatomic location and etiology into pulsion and traction diverticula. [ctsnet.org]

Each has a distinct etiology. The pulsion type is the most common form in the United States. [mhmedical.com]

Tuberculosis and histoplasmosis are known etiologies of this condition. 2 Figure 2. Lung biopsy showing dense fibrosis encasing hard granulomata composed of epithelioid histiocytes. [acgcasereports.gi.org]

Epidemiology

Epidemiology Rare diverticula compared to other gastrointestinal sites (prompting < 1% of all barium swallows and accounting for < 5% of all cases of dysphagia ). [amboss.com]

An excellent, up-to-date review of the epidemiology, etiology, clinical presentations, diagnosis, and management of esophageal diverticula. PubMed CrossRef Google Scholar 3. Jordan PH, Kinner BM: New look at epiphrenic diverticula. [link.springer.com]

Epidemiology Age Most esophageal diverticula occur in middle-aged adults and elderly people. Presentation in infants and children is rarely seen. [emedicine.medscape.com]

While there are differences between squamous cell carcinoma and adenocarcinoma in epidemiology, location and patterns of spread, both diseases tend to spread early outside the esophagus and both share a rather poor prognosis unless discovered early. [clevelandclinicmeded.com]

Pathophysiology

Pathophysiology (see “Pathophysiology” below) Pulsion Diverticula Traction Diverticula References: [1] [2] [4] [3] Pathophysiology Anatomy 3 constrictions of the esophagus The cervical constriction: beginning of the esophagus (upper esophageal opening [amboss.com]

Pathophysiology Esophageal diverticula are classified by location in the esophagus. Upper (pharyngoesophageal, Killian-Jamieson, or Zenker), middle, or lower (epiphrenic). [emedicine.medscape.com]

PATHOPHYSIOLOGY Virtually all mucosal injuries are accompanied by inflammation with various degrees of severity including from erythema, frank ulcers with potential scarring and bleeding and strictures. [clevelandclinicmeded.com]

In addition, they may be categorized by their pathophysiology as pulsion or traction types of diverticula. [aibolita.com]

Prevention

Endoscopy may be helpful in evaluating associated conditions, but must be performed with extreme caution to prevent perforation of the thin-walled diverticulum. [aibolita.com]

One advantage to an antireflux procedure is the prevention of acid reflux following the disruption of the gastroesophageal junction, which may occur if the myotomy is extended onto the gastric cardia. [ctsnet.org]

Antibacterial therapy is nominated for prevention of infection complications. In first two days after the burn the patients get parenteral feeding. [intranet.tdmu.edu.ua]

Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer. [en.wikipedia.org]

There are valves in most veins to prevent backflow, veins are present throughout the body as tubes that carry blood back to the heart. [wikivisually.com]

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