J Korean Med Sci.  2004 Dec;19(6):887-890. 10.3346/jkms.2004.19.6.887.

Delayed Primary Repair of Perforated Epiphrenic Diverticulum

• Lee JH
• Chae HS
• Kim KH
• Kim JW
• Wang YP
• Lee SH
• Jo KH
• Park JK
• Sim SB
• Yoon JS
• Moon SW
• Kim YH

• KMID: 1778574
• DOI: http://doi.org/10.3346/jkms.2004.19.6.887

Abstract

A 68-yr-old man complaining of sudden, postprandial chest pain visited the emergency room. His symptom had been aggravated during the preceding two days. Upper gastrointestinal contrast study with gastrographin showed leakage of dye from the epiphrenic diverticulum in the lower third of the esophagus. The primary repair was urgently carried out. Upper gastrointestinal contrast study 14 days after operation revealed an esophageal leakage which was small and confined. The patient was managed with conservative treatments such as intravenous hyperali-mentation and broad-spectrum antibiotics. Forty-two days after the operation, a gastrographin swallow study showed the absence of leaks. This is the first report-ed case of a perforated epiphrenic esophageal diverticulum repaired by delayed primary repair in Korea.

Keyword

Diverticulum, Esophageal; Esophageal Perforation

MeSH Terms

Aged
Diverticulum, Esophageal/complications/*diagnosis/*surgery
Esophageal Perforation/*diagnosis/etiology/*surgery
Esophagectomy/*methods
Humans
Male
Research Support, Non-U.S. Gov't
Time Factors
Treatment Outcome

Figure

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  Fig. 1 Preoperative radiography demonstrates a linear band of air (as shown by the arrow) paralleling to the trachea.

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  Fig. 2 Chest CT scan reveals periesophageal fluid collection in the lower esophagus, along with air collection around the esophagus.

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  Fig. 3 Upright view from contrast study shows a 2.5 cm-wide diverticulum and leak on the diverticulum in the left distal esophagus.

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  Fig. 4 During the surgery, epiphrenic diverticulum is observed as a mucosal protrusion between the muscular fibers on the left side of the lower thoracic esophagus. The perforation (as shown by the arrow) is revealed in the borderline between mucosal protrusion and muscular fiber.

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  Fig. 5 Radiography on the 2nd postoperative day shows the pulmonary edema, cardiomegaly, and widened mediastinum.

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  Fig. 6 Contrast study obtained on the 14th postoperative day shows the disappearance of the diverticulum, although the small and confined leak from the esophagus remains.

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