subphrenic esophageal diverticulum
Introduction
Introduction to the lower esophageal diverticulum The subphrenic sophistical diverticulum (subphrenicesophagealdiverticulum) is a diverticulum-like change that occurs in the esophagus of the abdomen. It is often found within 2 cm from the distal end of the gastroesophageal junction. It is located on the left esophagus of the ventral esophagus or anterior wall. The diverticulum can also sag to the lower part of the diaphragm. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: hiatal hernia
Cause
The cause of lower esophageal diverticulum
(1) Causes of the disease
The cause is not yet clear, and Cobum (1971) believes that it may be related to the inability of the distal esophageal sphincter to relax completely.
(two) pathogenesis
Pathological examination revealed that the diverticulum was a true subgingival esophageal diverticulum containing esophageal layers. The diverticulum epithelium was a stratified squamous epithelium with several tiny ulcerated areas on the surface, which was a recent bleeding site. No esophageal traction diverticulum patients could be seen. The lymph nodes or other adjacent structures that form adhesion to the local esophagus, therefore, the inferior esophageal diverticulum is presumed to be a bulging diverticulum.
Prevention
Underarm esophageal diverticulum prevention
There is no effective preventive measure for this disease. Therefore, when there are suspicious symptoms mentioned above, it should be checked in time to achieve the purpose of early detection, early diagnosis and early treatment.
Complication
Subgingival esophageal diverticulum complications Complications
Male patients reported by Rettig, combined with hiatal hernia and esophageal fistula.
Symptom
Underarm esophageal diverticulum symptoms Common symptoms Upper abdominal pain black stool
In 1962, Rettig reported the first case of the inferior esophageal diverticulum in the literature. The patient was a male, 44 years old. The main complaint was upper abdominal pain for 3 months. The pain occurred after eating. Occasionally, after vomiting undigested food, Induced upper abdominal pain; weight loss after 6.8 kg (15 lbs) after onset, upper gastrointestinal barium meal examination showed that the patient had a diverticulum under the left ankle, the neck of the diverticulum from the anterior wall of the esophagus; when the patient was doing Valsalva test (Valsalva maneuver) It can be seen that the diverticulum was inserted into the thoracic cavity through the esophageal hiatus through the esophageal hiatus. At the same time, the esophageal paralysis was merged. The patient underwent surgery after admission. During the operation, the infraorbital diverticulum was found from the right anterior wall of the abdominal esophagus. The proximal end is about 1.5cm, the length of the diverticulum is 5cm, the diameter of the bottom of the diverticulum and the neck are 5cm and 2cm respectively. The sputum contains a small amount of blood. After the operation of the diverticulum, the patient recovers smoothly. The upper gastrointestinal barium meal examination is not repeated. See the abnormality, the general morphology of the inferior esophageal diverticulum in the upper gastrointestinal barium meal examination and intraoperative exploration of the patient as shown in Figure 1, the patient did not do esophageal manometry before surgery.
The case reported by Coburn et al. is an 84-year-old female patient whose main symptoms are severe xiphoid pain, sometimes released to the back, with a history of up to 6 years. Pain under the xiphoid is aggravated after eating, in the supine position or right. In the lateral position, the pain can be relieved. The patient has no gastroesophageal reflux, anemia or melena. The upper digestive tract barium meal examination revealed that there is a diverticulum with a maximum diameter of 6 cm under the armpit. The diverticulum originates from the left anterolateral side of the esophagus.
Esophagoscopy showed that the mucosa of the esophagus was normal at 48 cm from the incisors. No diverticulum was found. A gastroscopic examination revealed a diverticulum opening about 1 cm from the proximal end of the cardia. The mucosa resembled the esophageal mucosa, and the esophageal manometry showed the esophageal distance. At 50cm, there is a high-pressure area of about 5cm. The patient confirmed that the esophageal muscle at the distal end of the high-pressure area 2cm (below the diverticulum) could not be completely relaxed during repeated swallowing. The esophageal manometry also found that the patient's entire lower esophageal pressure increased. The amplitude is up to 8.0 kPa (60 mmHg); when swallowing, the lower esophageal muscles undergo delayed contraction and contraction at the same time. However, during the upper gastrointestinal barium meal examination, there is no obvious delay or delay in the passage of the expectorant through the esophagus and into the gastric cavity. Cobum et al believe that the underarm esophageal diverticulum and abnormal esophageal pressure curve are caused by the inability of the distal esophageal sphincter to be completely relaxed. In this case, the underarm esophageal diverticulum is not treated surgically. After conservative treatment by internal medicine, The clinical symptoms improved, and after a follow-up of 1 year, the general health of the patient was good.
Combined with clinical manifestations, it is mainly diagnosed by X-ray barium angiography.
Examine
Examination of the lower esophageal diverticulum
1. Esophagoscopy: See the esophagus 48cm away from the incisors, the mucosa is normal, no diverticulum.
2. Gastroscopic examination: It was found that there was a diverticulum opening with a diameter of about 1 cm from the proximal end of the cardia, and the mucosa resembled the esophageal mucosa.
3. Esophageal manometry: It shows that the esophagus has a high-pressure area of about 5cm from the incisor 50cm. The patient confirmed that the esophageal muscle at the distal end of the high-pressure area 2cm (below the diverticulum) could not be completely relaxed during the repeated swallowing operation, and the whole lower esophageal pressure Elevated, the amplitude is as high as 60mmHg; when swallowing, the lower part of the esophageal muscle undergoes delayed contraction and concomitant contraction.
4. Upper gastrointestinal barium meal examination: the anterior sac of the cardia protrudes, and the thin strip mouth communicates with the esophagus. With the diaphragmatic activity, the shape of the diverticulum can change, and the expectorant passes through the esophagus and enters the gastric cavity without obvious delay. Or slow.
Cobum et al believe that the underarm esophageal diverticulum and abnormal esophageal pressure curve is due to the inability of the distal esophageal sphincter to be completely relaxed.
Diagnosis
Diagnosis and diagnosis of underarm esophageal diverticulum
Combined with clinical manifestations, it is mainly diagnosed by X-ray barium angiography.
