Intramural diverticulum

Introduction to the diverticulum in the esophageal wall The esophageal wall diverticulum (esophagealintramuraldiverticulum) is rarely seen as a benign lesion. It is characterized by a diffusely distributed, 1 to 3 mm exoskeleton of the esophageal wall. First described by Mendel in 1960, and later reported in the literature, more common in men 50 to 60, can also affect children and young people. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: pneumonia, atelectasis, lung abscess

Causes of diverticulum in the esophageal wall

(1) Causes of the disease

Pseudo-esophageal diverticulum is rare, and the cause is still unclear. It may be that after the esophageal inflammation, the mucosal glands are destroyed and expanded.

(two) pathogenesis

The pseudo-diverticulum can affect the full length of the esophagus, but it is more common in the upper esophagus, which is consistent with the distribution of the esophageal submucosal glands. The pathological changes are cystic dilatation of the esophageal submucosa, chronic inflammation around, and small abscess formation. The lesion is confined to the submucosal layer and does not involve the esophageal muscular layer. Inflammatory changes in the glandular duct and squamous metaplasia can cause the lumen to stenosis or complete obstruction, resulting in proximal expansion to form a pseudo-diverticulum.

Patients with diverticulum in the esophageal wall often have subclinical Candida infections in the esophagus, which may be secondary, especially in patients with diabetes.

Prevention of diverticulum in the esophageal wall

There is no effective preventive measure for this disease. Therefore, when there are suspicious symptoms mentioned above, it should be checked in time to achieve the purpose of early detection, early diagnosis and early treatment.

Diverticulum complications in the esophageal wall Complications pneumonitis atelectasis

Due to the accumulation of food, the diverticulum will continue to increase and gradually fall, which is not conducive to the discharge of the accumulation of the chamber, so that the opening of the diverticulum is facing the lower part of the throat. The swallowed food first enters the diverticulum and returns to the flow. Difficulties, and progressive progressive, some patients also have bad breath, nausea, loss of appetite and other symptoms. Some suffer from malnutrition and weight loss due to eating difficulties. In the absence of treatment, if the diverticulum gradually increases, the accumulated food and secretions begin to increase, sometimes automatically returning to the oral cavity, occasionally causing aspiration. The result of aspiration can lead to complications such as pneumonia, atelectasis or lung abscess. Hemorrhage, perforation and complication are less common.

Diverticulum symptoms in the esophageal wall Common symptoms Nausea and vomiting Nausea dysphagia Esophageal wall thickening Esophageal fistula

Esophageal pseudo-diverticulum is more common in the elderly, more men than women, often have varying degrees of difficulty swallowing.

Symptoms appear intermittent or slow progression, occasionally nausea, vomiting and pain, often complicated with esophageal fistula and mild stenosis, the diverticulum can occur above, below or in the middle of the stenosis.

Examination of diverticulum in the esophageal wall

In vivo histopathological examination showed only mild inflammatory changes in the superficial tissue.

1. X-ray examination: sometimes can not find the pseudo-diverticulum, sputum angiography can be found in the esophageal cavity, there are many long-necked flask-shaped or small button-shaped small pouches, ranging from 1 to 5mm in size, showing scattered or limited Distribution, the esophagus is obviously narrow, and there are more false diverticulum.

2. Endoscopy: The esophagus is chronically inflammatory, and the opening of the pseudo-diverticulum is seen in very few patients.

3. CT scan: difficult to display, combined with X-ray examination, see the local esophageal wall thickening, the internal cavity is uneven, the esophageal lumen can be narrow.

Diagnosis and differentiation of diverticulum in esophageal wall

Diagnostic and diagnostic criteria for the pharyngeal esophageal diverticulum: There are not many positive signs of clinical physical examination. Some patients repeatedly squeezing the anterior border of the sternocleidomastoid muscles after swallowing a few mouthfuls of air, and the sound can be heard.
The main method of diagnosis is X-ray examination. Occasionally, the liquid level is seen on the plain film. The diverticulum can be seen behind the esophagus. If the diverticulum is obviously pressed against the esophagus, it can be seen that after the expectorant enters the diverticulum, another tincture shadow flows from the chamber to the lower chamber. esophagus. Repeated changes in body position during angiography are conducive to the filling and emptying of the diverticulum. It is easy to find the small diverticulum and observe whether the mucosa in the sputum is smooth, except for early malignant transformation.
Endoscopy is dangerous and should not be used as a routine examination. It should only be performed if malignant changes or other malformations, such as esophageal fistula or esophageal stricture, are suspected. Before the endoscopy, the patient swallows a black silk thread as the guide wire of the endoscope, which can increase the safety of the examination. When the mirror is not visible at the mirror end or when the thread is seen, the mirror end has entered. Diverticulum.
Diagnostic and diagnostic criteria for supraorbital sacral diverticulum: The supraorbital diverticulum is often diagnosed by chest X-ray. The chest radiograph can sometimes see the diverticulum cavity containing the fluid level. The sputum angiography sees the diverticulum a few centimeters above the iliac crest, often to the right side, or to the left or front. It is extremely rare to have a diverticulum in the esophagus of the lower abdomen. The diverticulum can be combined with hiatal hernia at the same time. It should be observed in multiple directions during angiography to avoid missed diagnosis or misdiagnosis.
Endoscopy is dangerous and only occurs when malignant and suspected malformations are suspected.
The middle esophagus diverticulum is also diagnosed by X-ray. When the sputum angiography is performed, the supine position or the low head position should be used, and the position should be rotated left and right to clearly show the contour of the diverticulum. Because the opening of the diverticulum in the middle esophagus is relatively large, the contrast agent is very It is easy to flow out of the chamber and is not easy to stay in the memory.
Endoscopy is not helpful for the small diverticulum in the middle of the esophagus, only when it is suspected that the diverticulum is malignant.
Diagnostic and diagnostic criteria for pseudo-esophageal diverticulum: false diverticulum can not be found on X-ray examination. Long-necked flasks or small button-shaped pouches with multiple hairs can be found in the esophageal lumen, ranging from 1 to 5 mm. There are scattered or limited distribution, obvious narrow esophagus, and more false diverticulum, so it is considered that esophageal stricture is related to inflammation around the pseudo-diverticulum.
Endoscopic examination of the esophagus showed chronic inflammatory changes, and only a very small number of patients saw a false sputum opening, biopsy is not easy to diagnose.

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