Esophagus diverticulum

In 1840, the Austrian pathologist Karl Rokitansky for the first time systematized the diverticulums of the esophagus, dividing them into pulsion and traction.

• Pulsed diverticulums are formed due to protrusion of the mucous membrane of the esophagus under the action of high intraesophageal pressure, which occurs during contraction of the esophagus.
• Traction diverticuli are caused by the occurrence of an inflammatory process in the surrounding tissues and the formation of scars that stretch all layers of the esophagus wall towards the affected organ.

Typically, the traction mechanism is observed at the very beginning of the development of the diverticulum, and then the pulsion factors join in and the diverticulum becomes pulsion-traction ^[1] .

The classification of esophageal diverticulums is based on their localization:

• Pharyngeal-esophageal diverticula (Zencker diverticulum, accounts for approximately 60% of all esophageal diverticula)
• Bifurcation diverticula
• Epiphrenic diverticula

True and false diverticula are also distinguished. The walls of true diverticulums contain all layers of the esophagus, and the muscle layer is absent in the walls of the false ^[2] .

Pharyngeal-esophageal diverticulums

Usually come from the posterior pharyngeal wall at the level of the cricoid cartilage of the trachea, where there is an area that is not covered by muscles (Lanier-Hackerman triangle). Such diverticulums by the mechanism are pulsional.

Bifurcation diverticulums

The development of such diverticulums, as a rule, is facilitated by inflammatory processes in the lymph nodes and other formations of the mediastinum, which lead to the development of adhesions, scarring and stretching of the wall of the esophagus. These diverticula are located on the anterior or anterior right wall of the esophagus and are tractional in their mechanism.

Epiphrenic diverticulums

They are located in the lower third of the esophagus on the anterior or anterior right wall of the esophagus. By their mechanism, they are pulsion. The main reason for the occurrence of such diverticula is the congenital weakness of the esophagus wall in this area.

Symptoms of the disease are varied and depend on the location and strength of the lesion.

• The pharyngeal-esophageal diverticulum (Zenker diverticulum) does not manifest itself in the initial stage, sometimes patients feel a feeling of "scratching" in the throat while eating. When the disease progresses into the diverticulum, food enters and compression of the esophagus occurs, in connection with this, characteristic symptoms appear - dysphagia, regurgitation, aspiration during sleep, halitosis. With a large diverticulum, a protrusion can be detected in the left half of the neck, with a pressure on which a characteristic "rumbling" is heard
• Small bifurcation diverticulums are asymptomatic and are detected by chance. With large sizes, the following symptoms can be detected: heartburn, belching, regurgitation, pain in the epigastric region, hypersalivation. Perforation of the diverticulum into the superior vena cava or aorta is possible, which causes fatal bleeding into the lumen of the esophagus.
• Epiphrenic diverticula with small sizes are asymptomatic. With large sizes, the symptoms are similar to those of bifurcation diverticulums, however, the pain is very similar to those with angina pectoris ^[2] .

The main method in the diagnosis of diverticulums is a polypositional radiopaque study , which allows you to identify the localization, shape, size of the diverticulum. In the role of contrast, a barium mixture is used. An esophagoscopic examination is also necessary to detect changes in the mucosa, as well as the presence of various complications (bleeding, polyp, cancer).

Conservative treatment is indicated for patients with small easily emptying diverticula, a meager clinical picture, without complications. The patient is prescribed a diet, taking vegetable oil before meals and a few sips of water after eating.

With diverticula greater than 2 cm, surgical treatment is indicated; diverticulectomy is performed ^[1] .

1. ↑ ^{1 2} Kuzin M.I. Surgical diseases. - 3. - Medicine, 2012 .-- S. 184-186. - 784 p. - ISBN 5-225-00920-4 .
2. ↑ ^{1 2} A.F. Chernousov. Surgical diseases. - The second one. - Practical medicine, 2017 .-- S. 185-188. - 504 s. - ISBN 978-5-98811-384-3 .