횡격막직상부 식도계실 3례

Epiphrenic Diverticulum of the Esophagus

The first case was a 20 year old female who has been suffered from epigastric pain, and anorexia for 2 years. A thumb tip sized pulsion diverticulum 4cm above the esophagocardial junction was elicited by esophagogram and on exploration. A diverticulectomy with long esophagocardiomyotomy was performed. The second case was a 30 year old house wife who has had postprandial epigastric pain for 2 months accompained with frequent vomiting. Fiberscopy and esophagogram showed epiphrenic diverticulum of the esophagus. Same operative procedures were carried out and obtained a good result as first case. The third case was a 55 year old house wife who was admitted to this Chest Surgery Department because of regurgitation and intermittent vomiting for approximately 3 months. Esophagogram showed a large epiphrenic diverticulum of the esophagus. On exploration, a tennis ball sized pulsion diverticulum was found on the anterolateral wall of the esophagus. A partial esophagectomy including the diverticulum and esophagoesophagostomy was performed. The specimenshowed some erosive changes of the mucosal surface of the diverticulum and also the esophagus suggestive of diverticulitis and esophagitis. She has been satisfactory result until 4 months postoperatively, when she developed regurgitation and epigastric pain. Esophagogram showed stenosis of the operative site. Readmission and esophageal dilatations were done and improved without any problem. Epiphrenic or supradiaphragmatic diverticulum of the esophagus is a rare condition. Pathophysiologically, the conditions accompanied the spasm of the esophagus, many authors prefered the procedures of a diverticulectomy plus long esophagocardiomyotomy rather than simple diverticulectomy or esophagectomy and esophagoesophagostomy. Here we report the cases and reviewed the literatures.