Esophageal obstruction

Introduction Negus (1950) believes that the cause of the pharyngeal esophageal diverticulum may be due to the presence of an anatomically weak point (zone) in the pharyngeal muscle and obstruction of the esophageal lumen at the distal end of the pharyngeal muscle. The pharyngeal esophageal diverticulum is the most common esophageal diverticulum located proximal to the posterior pharyngeal muscle, or the posterior wall of the pharyngeal esophageal junction above the pharyngeal muscle. The etiology of the pharyngeal esophageal diverticulum is not fully understood. Because the pharyngeal esophageal diverticulum is more common in patients over the age of 50, and occurs in people under the age of 30, it is generally considered that the pharyngeal esophageal diverticulum is an acquired disease. Since all of these conditions can reduce the diameter of the esophageal lumen, they often cause swallowing of solid food.

Cause

The etiology of the pharyngeal esophageal diverticulum is not fully understood. Because the pharyngeal esophageal diverticulum is more common in patients over the age of 50, and occurs in people under the age of 30, it is generally considered that the pharyngeal esophageal diverticulum is an acquired disease. Since all of these conditions can reduce the diameter of the esophageal lumen, they often cause difficulty in swallowing solid foods, especially meat and bread, while liquids are not difficult. Dysphagia occurs in other long-term symptoms, such as severe heartburn, periodic nighttime or streak behind the sternum. This difficulty in swallowing gradually worsens over the years, and dysphagia caused by esophageal cancer is rapidly progressively worsened in weeks or months.

an examination

Related inspection

Esophagography esophageal barium meal perspective

Symptoms and signs: patients with pharyngeal esophageal diverticulum can have no clinical symptoms, but most patients have symptoms in the early stage of the disease, the volume of the diverticulum is progressively increased, and the patient's symptoms gradually worsen, the frequency or frequency of symptoms is increasing. And complications may occur.

Typical clinical symptoms of patients with pharyngeal esophageal diverticulum include difficulty in swallowing of the high neck esophagus, respiratory odor, pharynx when swallowing food or drinking water, whether coughing or not coughing, patients often have spontaneous esophagus Content reflux phenomenon. Typical reflux products are fresh, undigested foods that are neither bitter or sour or contain gastroduodenal secretions. Individual patients develop esophageal reflux immediately after eating. This reflux is associated with severe cough and suffocation caused by the contents of the diverticulum being inhaled into the airway. Due to esophageal reflux and cough, the patient's feeding process is slow and laborious.

As the volume of the pharyngeal esophagus continues to increase, the patient's pharynx often has a feeling of bloating, and the feeling of the affected side can be alleviated or alleviated by hand pressing the affected side of the neck. Occasionally, the patient comes to see a doctor because of the stench of the contents of the diverticulum. Very few patients complain that there is a soft mass in their neck.

Differential diagnosis

The esophageal diverticulum refers to a saclike protrusion that communicates with the esophagus. Its classification is more complicated, according to the location of the disease can be divided into the pharyngeal esophageal diverticulum, the middle esophagus diverticulum and the upper esophageal diverticulum.

The supraorbital diverticulum is also a bulging diverticulum. The diverticulum wall has only a mucosal layer and a submucosal layer, and there are few muscle fibers. Most literature reports that most of the supraorbital diverticulum is associated with esophageal motor dysfunction, esophageal hiatus hernia, and esophageal reflux. Esophageal reflux often causes esophageal muscle spasm, causing an increase in pressure in the esophageal lumen and causing a bulging diverticulum.

The diverticulum of the middle esophagus can be bulging or pull-out type, most of which are the pull-out type diverticulum. The etiology and performance of the dilated esophageal diverticulum and the supraorbital diverticulum are completely similar, while the pull-out type diverticulum is due to inflammation of the parabronchial lymph nodes or tuberculosis. Caused by scar traction, it has a full-thickness tissue of the esophagus, including the mucosa, submucosa and muscle layers, and the neck is narrow and narrow like a tent. The pull-out type diverticulum occurs mostly in the anterior and right wall of the esophagus at the bifurcation of the trachea. Some authors believe that a part of the esophageal diverticulum that is unrelated to abnormal esophageal movement is a congenital intestinal cyst or esophageal duplication. Pseudo-esophageal diverticulum is rare, and the cause is not clear.

The pathological change is due to the dilatation of the esophageal submucosal gland, and the lesion is confined to the submucosal layer and does not involve the esophageal muscle layer. The dilated gland is cystic, with chronic inflammation around it and possibly a small abscess. Inflammatory changes in the glandular tube and squamous metaplasia can cause the lumen to stenosis or complete obstruction, resulting in proximal expansion to form a pseudo-diverticulum. Due to chronic inflammation, the esophageal submucosal fibrosis causes thickening of the esophageal wall, stiffness, and narrow lumen. Pseudo-diverticulum can affect the full length of the esophagus, but is more common in the upper esophagus, which is consistent with the distribution of submucosal glands in the esophagus. Many patients with pseudo-diverticulosis are also diabetic.

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