Diverticulum of the esophagus is a disease in which the esophagus wall protrudes in the form of a sac or a blind tube. As a result, the function of swallowing or moving food through the esophagus may be impaired. The disease affects both women and men, mainly after 40 years.
Classification of esophageal diverticula
- By origin, diverticula are divided into:
- congenital;
- acquired.
- pulsionary diverticulum of the esophagus - is formed as a result of protrusion of the mucosa under the influence of increased intra-esophageal pressure arising during the reduction of the esophagus;
- tractional diverticulum - is caused by the inflammatory process in the adjacent tissues and the formation of scars, stretching all layers of the esophagus wall towards the affected organ.
- true diverticulum - is formed by protrusion of all layers of the esophagus (mucosa, submucosa, muscle membranes);
- false diverticulum (pseudodiverticulum) - is formed only by the mucosa of the esophagus.
- pharyngeal-esophageal;
- epibronchial;
- epiphrenic.
Causes of esophageal diverticulum
The cause of congenital diverticula is the inferiority of the muscular membrane and connective tissue of the esophagus. Acquired diverticula are formed for two main reasons:
- as a result of the inflammatory process (mediastenitis, tuberculosis of the intrathoracic lymph nodes, chronic casting of stomach contents into the esophagus, trauma of the esophagus as a result of the operation, consequences of chemical burns of the esophagus, etc.);
- due to impaired motor function or weakness of the connective tissue framework of the esophageal wall, associated with aging of the body.
Symptoms of esophageal diverticulum:
- an unpleasant putrefactive odor from the mouth ;
- difficulty in swallowing and passing food;
- regurgitation (sometimes with food that was eaten a few days ago);
- pain in the site of localization of protrusion;
- sensation of a coma, foreign body in the throat;
- nausea;
- sore throat;
- dry cough (mostly at night);
- salivation.
The pharyngeal esophageal diverticulum (Zenker's diverticulum) can be seen on the neck with the head tilted back, palpable (soft touch).
Diagnosis of esophageal diverticulum
The main diagnostic method for confirming the diagnosis is an X-ray study with a sip of barium. Less commonly, endoscopy of the esophagus is used because of the risk of damage to its walls.
How to treat the diverticulum of the esophagus?
Conservative treatment of the esophageal diverticulum is carried out in the case of a small protrusion and in the absence of complications.
An important point in the treatment process is the maintenance of a diet that includes the use of carefully crushed, soft food. After eating, you should definitely drink a little water or unsweetened tea to "flush" the diverticulum.
Surgery for esophageal diverticulum is indicated in such cases:
- development of complications (bleeding, esophagus stenosis, fistula appearance, perforation, penetration, etc.);
- diverticula of large size;
- prolonged food delay in the diverticulum irrespective of its size.
The essence of surgical treatment is the complete removal of the diverticulum. Recently, in the surgery of diverticula, modern methods of their removal with the help of videotorakoscopic techniques are becoming increasingly widespread.