congenital esophageal diverticulum
Introduction
Introduction to congenital esophageal diverticulum Congenital esophageal diverticulum is rare. According to the location of the site, it is divided into pharyngeal esophageal diverticulum, esophageal diverticulum and congenital esophageal stricture and true congenital esophageal diverticulum. Whether the esophageal diverticulum produces last night's symptoms is related to the size of the diverticulum, the location of the opening, the presence of food and secretions, and most of the symptoms are mild and atypical. basic knowledge The proportion of illness: 0.001% Susceptible people: young children Mode of infection: non-infectious Complications: pneumonia, atelectasis, lung abscess
Cause
Congenital esophageal diverticulum
(1) Causes of the disease
The disease is more common in men aged 50 to 60 years. It can also affect children and young people. Symptoms are mainly less severe dysphagia, with intermittent episodes and sometimes progressive exacerbations. About one-third of patients have symptoms of gastroesophageal reflux and have esophageal strictures.
According to the patient's progressive dysphagia combined with gastroesophageal reflux symptoms, barium meal and endoscopy can confirm the diagnosis.
(two) pathogenesis
The cause is unclear and may be caused by abnormal embryonic development.
Prevention
Congenital esophageal diverticulosis prevention
Keeping a low-fat diet, fat can slow down the passage of food through the intestines. Perform some food-sensitive tests to find foods that are irritating to your digestive system and should be avoided. In the acute exacerbation of diverticulitis, try to control the diet 1-3 times a day with water or vegetable juice. When the diverticulum is still inflammatory and sensitive, eat low-volume foods (broth and low-fiber diet).
Complication
Congenital esophageal diverticulum complications Complications pneumonitis atelectasis
Due to the accumulation of food, the diverticulum will continue to increase and gradually fall, which is not conducive to the discharge of the accumulation of the chamber, so that the opening of the diverticulum is facing the lower part of the throat. The swallowed food first enters the diverticulum and returns to the flow. Difficulties, and progressive progressive, some patients also have bad breath, nausea, loss of appetite and other symptoms. Some suffer from malnutrition and weight loss due to eating difficulties. In the absence of treatment, if the diverticulum gradually increases, the accumulated food and secretions begin to increase, sometimes automatically returning to the oral cavity, occasionally causing aspiration. The result of aspiration can lead to complications such as pneumonia, atelectasis or lung abscess. Hemorrhage, perforation and complication are less common.
Symptom
Congenital esophageal diverticulum symptoms Common symptoms Esophageal tracheal fistula, dyspnea, esophageal atresia, fistula between the airway and esophagus
There are few reports of esophageal diverticulum. The pharyngeal chamber occurs in the junction of the pharyngeal esophagus or the hypopharynx. The clinical manifestations include salivation and difficulty in breathing when eating. It can be misdiagnosed as esophageal atresia combined with esophageal tracheal fistula. If you insert a nasogastric tube, you can enter the diverticulum. Congenital esophageal diverticulum with congenital esophageal stricture may be a variant of esophageal atresia. True congenital esophageal diverticulum is not associated with other esophagus, tracheal malformation, and is rare, and may be a variant of repeat deformity. Inside or outside the wall.
Examine
Congenital esophageal diverticulum examination
Esophageal barium meal examination can be seen in the angiography. The anterior wall of the diverticulum from the pharynx-esophageal junction is equivalent to the level of the hypopharynx. The front is the obstruction of the larynx. The diverticulum extends downward. The size of the diverticulum is different. It is conditional or bag-shaped. It can be biased to one side, the edge of the diverticulum is smooth and tidy, and the blind end is round and blunt. If there is food residue in it, it can cause filling defects. It should be noted that the contrast agent is easy to enter the respiratory tract during diverticulum angiography of the pharynx.
Diagnosis
Diagnosis and diagnosis of congenital esophageal diverticulum
Diagnostic points
Esophageal X-ray angiography can confirm the diagnosis.
Diagnostic and diagnostic criteria for the pharyngeal esophageal diverticulum: There are not many positive signs of clinical physical examination. Some patients repeatedly squeezing the anterior border of the sternocleidomastoid muscles after swallowing a few mouthfuls of air, and the sound can be heard.
The main method of diagnosis is X-ray examination. Occasionally, the liquid level is seen on the plain film. The diverticulum can be seen behind the esophagus. If the diverticulum is obviously pressed against the esophagus, it can be seen that after the expectorant enters the diverticulum, another tincture shadow flows from the chamber to the lower chamber. esophagus. Repeated changes in body position during angiography are conducive to the filling and emptying of the diverticulum. It is easy to find the small diverticulum and observe whether the mucosa in the sputum is smooth, except for early malignant transformation.
Endoscopy is dangerous and should not be used as a routine examination. It should only be performed if malignant changes or other malformations, such as esophageal fistula or esophageal stricture, are suspected. Before the endoscopy, the patient swallows a black silk thread as the guide wire of the endoscope, which can increase the safety of the examination. When the mirror is not visible at the mirror end or when the thread is seen, the mirror end has entered. Diverticulum.
Diagnostic and diagnostic criteria for supraorbital sacral diverticulum: The supraorbital diverticulum is often diagnosed by chest X-ray. The chest radiograph can sometimes see the diverticulum cavity containing the fluid level. The sputum angiography sees the diverticulum a few centimeters above the iliac crest, often to the right side, or to the left or front. It is extremely rare to have a diverticulum in the esophagus of the lower abdomen. The diverticulum can be combined with hiatal hernia at the same time. It should be observed in multiple directions during angiography to avoid missed diagnosis or misdiagnosis.
Endoscopy is dangerous and only occurs when malignant and suspected malformations are suspected.
The middle esophagus diverticulum is also diagnosed by X-ray. When the sputum angiography is performed, the supine position or the low head position should be used, and the position should be rotated left and right to clearly show the contour of the diverticulum. Because the opening of the diverticulum in the middle esophagus is relatively large, the contrast agent is very It is easy to flow out of the chamber and is not easy to stay in the memory.
Endoscopy is not helpful for the small diverticulum in the middle of the esophagus, only when it is suspected that the diverticulum is malignant.
Diagnostic and diagnostic criteria for pseudo-esophageal diverticulum: false diverticulum can not be found on X-ray examination. Long-necked flasks or small button-shaped pouches with multiple hairs can be found in the esophageal lumen, ranging from 1 to 5 mm. There are scattered or limited distribution, obvious narrow esophagus, and more false diverticulum, so it is considered that esophageal stricture is related to inflammation around the pseudo-diverticulum.
Endoscopic examination of the esophagus showed chronic inflammatory changes, and only a very small number of patients saw a false sputum opening, biopsy is not easy to diagnose.
