Laparoscopic Treatment of Bilateral Esophageal Epiphrenic Diverticula

Epiphrenic diverticula are rare and usually incidentally found. When symptomatic they tend to present with chest pain, regurgitation and dysphagia.
We report a case of large bilateral epiphrenic diverticula presented with upper gastrointestinal bleeding treated laparoscopically.
A 67 year-old woman with a known history of systemic lupus erythematosus steroid dependent and mild dysphagia, presented to the emergency room with “hemopthysis”. The bronchoscopy was negative, but an esophagogastroduodenoscopy revealed 2 large epiphrenic diverticula with signs of recent bleeding in one of them. Further work up included a barium swallow that confirmed the presence of 2 epiphrenic diverticula of 4 to 5 cm and proximal esophageal dilatation. No manometric evaluation was performed. The patient underwent elective laparoscopic resection. Because of the proximal extension of the diverticula, the esophageal dissection was carried out well up into the mediastinum. The diverticulectomy was performed using bovine pericardium staple line reinforcement under endoscopic view. During the myotomy a tight circular muscle was found at the gastro-esophageal junction. The myotomy was extended into the stomach in standard fashion. An anterior Dor partial fundoplication was also utilized.
Results: There were no intraoperative complications. The postoperative barium swallow showed adequate myotomy and no evidence of leak. A liquid diet was resumed on postoperative day 4. Ten days postoperatively, she was re-admitted for chest pain, right lower lobe pneumonia and pleural effusion, but no evidence of staple line leak. She underwent percutaneous drainage with resolution of her symptoms.
Bilateral epiphrenic esophageal diverticula are exceedingly rare. Besides the common symptoms, they can present with hematemesis. Because of the superior visualization and the avoidance of thoracotomy, a trans-abdominal laparoscopic approach should be considered for their treatment.

Session: Podium Video Presentation

Program Number: V010

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