achalazia diverticul

7/29/2019 achalazia diverticul

1/65

E S O P H A G E A L

DIVERTICULA


2/65


3/65


4/65


5/65


6/65


7/65


8/65


9/65

Is a completely epithelial-lined

blind pouch or pocket leadingfrom the main lumen of the

esophagus


10/65

Classification

Pulsion typeprotrusion of

mucosa and submucosa

Traction typepulling outward ofthe esophageal wall


11/65

I.Pharingoesophageal

(ZENKER)

diverticulum


12/65


13/65


14/65


15/65


16/65

Clinical Findings

A.Symptoms and signs

- dysphagia

- undigested food regurgitation

- manually massage of the neck toempty the sac

- gurgling sound in the neck

- halitosis, metallic taste


17/65

Clinical Findings

B. Imaging study

- barium

- endoscopy

- manometry and ph studies

- CT scan


18/65

Radiology


19/65


20/65

Endoscopy


21/65

CT scan


22/65

Manometry


23/65

Essentials of diagnosis

Dysphagia, pressure symptom and

gurgling sound in the neck

Regurgitation of undigested food,

halitosis.

Manual emptying of the diverticulumby the patient


24/65

Differential Diagnosis

Malignant lesions

Achalasia of the cricofaringeus muscle

Cervical esophageal webs


25/65

Complications

Aspirationtracheobronchial irritation

and pneumonitis

Perforationmediastinitis,

paraesophageal abcess

Bleeding


26/65

Treatment

Surgery is the treatment of choice cricopharyngeal miotomy

diverticulectomy


27/65


28/65


29/65

RESULTS

Postoperative complications

- are rare recurrent nerve palsy

esophagocutaneus fistula

Able to eat day after surgery


30/65

II.

Thoracic diverticulum


31/65

General considerations

Lower third localisationAssociated with motility disturbance

Frequently lunch


32/65

Clinical findings

A. Symptoms and signs

-dysphagia

-regurgitation

-aspiration

-pulmonary symptoms

B. Imaging studies

-radiology

-manometry


33/65

Epiphrenic diverticulum


34/65

Epibroncheal

diverticulum

Epiphrenic

diverticulum


35/65


Dysphagia and pressure sensation inthe lower esophagus after eating

Vomiting, substernal painRadiology

Disturbed motility of the loweresophagus

Associated hiatal hernia on occasion


36/65

Differential diagnosis

Achalasia

Hiatal hernia

Benign or malignant stenosis


37/65

Complications

Esophagitis

Periesophagitis

Bleeding

Perforation - rarely


38/65

Surgical

treatment


39/65

Prognosis

Successful in 8090 % of cases


40/65

Laparoscopic aproach


41/65

Traction diverticulum

Appears to parallel

that of specific

inflamatory disease

Symptmatology

occasionally


42/65

A C H A L A S I A


43/65

General consideration

Neuromuscular disorders with

esophageal dilatation without organic

stenosis

Cardiospasm

Sir Cooper Perry, Thomas Willis


44/65

Ethiopatogeny

Abscense, atrophy, disintegration of the

ganglion cells of Auerbachs myenteric

plexuses Two theories - degenerative disease of the

neurons

- infectionChagas disease Peak years 3060; affects more males


45/65

Clinical Findings

Dysphagia

Retention of ingested food

Pain

Regurgitation

Aspiration


46/65

Imaging studies

Radiology Endoscopy

Manometry


47/65


48/65


49/65

Manometry


50/65


51/65

Endoscopy


52/65


Dysphagia

Retention of ingested food

Radiology - absent primary peristalsis

- dilated body of esophagus

- conically narrowed

cardioesophageal junction

Manometryabsent primary peristalsis


53/65

Differential diagnosis

Benign strictures

Cardioesophageal junction carcinoma

Epiphrenic diverticulum


54/65

Complications

Mucosal ulcerations

Bleeding

Aspiration - pneumonitis,- tracheobronchitis

Malnutrition mild to moderate

Malignant degeneration3-5%squamous cell


55/65

Treatment

Surgery Heller myotomy

Open laparatomy or

thoracotomy

Laparoscopy

Thoracoscopy

Dilatation

Medicalcalcium channel blockers


56/65


57/65


58/65


59/65


60/65

Laparoscopic Heller procedure


61/65


62/65

Technique


63/65

Technique


64/65

Technique


65/65

Prognosis

85-90% good results

Documents

achalazia diverticul