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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2006 August;19(4):285-7
Laparoscopic treatment of mid-thoracic diverticulum due to nutcracker esophagus. A case report
Dado G., Favero A., Piccoli E., Bresadola F., Bresadola V.
Department of General Surgery, University of Udine, Udine, Italy
Mid-thoracic diverticula are uncommon and represent about 15-30% of all esophageal diverticula. They are often asymptomatic, but sometimes they are diagnosticated in patients with ingravescent dysphagia, regurgitation of food, sialorrhea, halitosis and weight loss. When associated with gastroesophageal reflux disease, acid reflux and retrosternal pyrosis may be present. The genesis of mid- thoracic diverticula (called also parabronchial) is storically attribuited to “traction” mechanism based on the presence of scare tissue between the diverticulum and the phlogistic lymph nodes of the mediastinum when tubercular infection was more frequent. Subsequently, also “pulsion” mechanism was considered for their genesis as for Zenker’s and epiphrenic esophageal diverticula. In fact in the Seventies, when esophageal manometry was introduced, the presence of esophageal motor disorders in the majority of these patients was observed (diffuse esophageal spasm, aspecific motor disorders, etc.). Now also a “traction-pulsion” mechanism is accepted, due to postinflammatory traction involving the esophageal wall causing segmentary dyskinesia of the esophageal body leading to altered pressure 1, 2. We report the case of a 60-year-old male patient with a symptomatic mid-thoracic diverticulum associated with a “nutcracker” esophagus (defined as the presence of peristaltic contractions with the average distal esophageal amplitude > 180 mmHg) successfully treated with laparoscopic extramucous myotomy.