Mid-esophageal diverticulum

Introduction to the middle esophagus The diverticulumoftheesophagealmidtpiece is mainly a traction diverticulum, occasionally a congenital diverticulum and a bulging diverticulum caused by a stenosis of the esophagus. basic knowledge The proportion of illness: 0.081% Susceptible people: no special people Mode of infection: non-infectious Complications: lung abscess esophageal diverticulum

Esophageal diverticulum

(1) Causes of the disease

The traction diverticulum in the middle esophagus is mostly caused by scar contraction and traction of the mediastinum or hilar lymph node tuberculosis, and a few are caused by pericarditis or spinal tuberculosis and the esophagus.

(two) pathogenesis

It occurs mostly in the side wall of the esophagus behind the left and right bronchus bifurcation. In about 2/3 of the cases, the diverticulum develops to the left and the anterior side of the esophagus, and there are few developers to the rear. Because the wall of the diverticulum is composed of layers of the esophageal wall. It is a true diverticulum and only bulges outward without sagging. Therefore, it does not accumulate food, it is not easy to cause inflammation, and it is not easy to cause obstruction of the esophageal cavity. However, due to the adhesion of scar tissue, it can affect the peristalsis of the esophagus. In the diverticulum, inflammation, bleeding, abscess formation or rupture into the mediastinum can occur. Because of the scar tissue around the diverticulum, acute perforation rarely occurs, and the diverticulum breaks into the aorta and causes massive hemorrhage, or penetrates the trachea to form the esophageal tracheal fistula. Reports, as well as reports of nonfatal bleeding from the diverticulum into the bronchial artery, may be due to broken texture of the granulation tissue, or calcified tissue corroding the bronchial artery, Dukes and Maclarty pointed out that mediastinal granuloma The condition involving the esophagus is rare, but sometimes the esophagus can be compressed, causing the narrow esophagus to form a diverticulum or sinus, and the formation of an esophageal tracheal fistula.

Middle esophageal diverticulosis prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Middle esophageal diverticulum complications Complications, lung abscess, esophageal diverticulum

It is more common that the lymph nodes become inflamed and adhere to the esophageal wall. The diverticulum can enter the respiratory tract by the inflammatory ulcer or lymph node necrosis. The small fistula can penetrate the bronchus without symptoms. The fistula enlargement can cause paroxysmal cough during swallowing fluid. It can also cause complications of lung abscess. The fistula enters the bronchial artery or esophageal artery and causes bleeding. It is reported by Hu Ronghua (1962) that one case of esophageal diverticulum broke into the pericardium, and the pericardium was worn to the thoracic and abdominal wall for food accumulation and abscess.

Esophageal diverticulum symptoms common symptoms esophageal obstruction esophageal reflux symptoms post-sternal pain esophageal bleeding dysphagia swallowing pain

Although the middle esophageal traction type diverticulum can cause complications such as hemorrhage, fistula and esophageal obstruction, it is generally asymptomatic without complications, and is occasionally found when X-ray barium meal examination. This diverticulum has a complete muscle layer, which ensures the emptying of the diverticulum and is not easy to induce symptoms. If combined with diverticulitis, the patient may feel swallowing pain and swallowing blockage, chest and back or sternal pain, chest fullness or a small amount of vomiting and other clinical symptoms. If the patient is lying down, sometimes food can be refluxed from the sputum to the mouth. These symptoms may also be related to esophageal compression or stenosis, and some patients may have localized esophagitis.

According to clinical manifestations, combined with esophageal barium meal and esophagoscopy can confirm the diagnosis.

Examination of the middle esophagus diverticulum

1. X-ray barium meal inspection

Most of the bulging diverticulum with a spherical shape and a narrow neck are in the form of a pull-type diverticulum. Due to the large opening of these diverticulum, the elixir is easy to flow out during the standing examination, and the diverticulum is difficult to develop. Low foot height, or prone position or left lateral position, the diverticulum is easier to display, the esophageal movement (such as emptying delay) and coexisting esophageal disease should be observed during barium meal examination, bronchial lipiodol is suspected when combined with bronchospasm Contrast X examination is more likely to detect lesions. X-ray signs when there are malignant changes in the diverticulum cavity are: 1 filling defect or irregular wall, until the diverticulum completely disappears, replacing it with filling defect; 2 the esophageal opening at or near the opening of the diverticulum, even There is stiffness; 3 the function of the wall near the esophageal diverticulum changes, the peristaltic contraction becomes weaker or even disappears, causing the contrast agent to stay, and sometimes it is difficult to identify inflammation in the sputum, and further endoscopy is required.

2. Esophageal manometry

The esophagus can be found to have abnormal motor function, such as diffuse esophageal fistula, achalasia and the like.

3. Tracheoscopy

For patients suspected of diverticulum malignant transformation and esophageal tracheal fistula complications, it is helpful to find the mouthwash. The patient is given oral methylene blue solution. If methylene blue is found in the bronchoscope or coughed sputum, the esophagus can be determined. Bronchospasm.

4. CT examination

In addition to other more serious diseases, if the patient has symptoms of chronic lung suppuration, a CT scan of the lung can determine the extent of the lung lesion.

Diagnostic identification of diverticulum in the middle esophagus

According to clinical manifestations, combined with esophageal barium meal and esophagoscopy can confirm the diagnosis.

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