Author:
Fujinaga Atsuro,Shibata Tomotaka,Etoh Tsuyoshi,Tada Kazuhiro,Suzuki Kosuke,Nishiki Kohei,Ogawa Katsuhiro,Kono Yohei,Hiratsuka Takahiro,Akagi Tomonori,Ueda Yoshitake,Toujigamori Manabu,Shiroshita Hidefumi,Shiraishi Norio,Inomata Masafumi
Abstract
Abstract
Background
An esophageal diverticulum is rare and is frequently associated with esophageal motility disorders. Jackhammer esophagus is also rare, is characterized by esophageal hypercontraction, and comprises 4.1% of esophageal motility disorders. Here, we report a case of a patient successfully treated by laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus diagnosed with high-resolution manometry (HRM).
Case presentation
The patient was a 78-year-old man who presented to the hospital with dysphagia. A diverticulum was detected in the lower part of his esophagus by upper gastrointestinal endoscopy. HRM was performed to investigate esophageal motility disorders. His integrated relaxation pressure was normal at 25.9 (< 26) mmHg, but his distal contractile integral (DCI) was very high at 21,464 (1500–13,000) mmHg s cm. Esophageal peristalsis was preserved. Therefore, the patient was diagnosed as having an epiphrenic esophageal diverticulum derived from a jackhammer esophagus for which laparoscopic transhiatal diverticulectomy and Heller-Dor procedure were performed. The postoperative course was uneventful. His symptoms improved, and the level of DCI also returned to a normal level of 3867 mmHg s cm at 2 months after the operation.
Conclusion
Laparoscopic transhiatal diverticulectomy and esophagomyotomy can be useful procedures for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus due to their lower invasiveness.
Publisher
Springer Science and Business Media LLC
Reference20 articles.
1. Postlethwait RW. Diverticula of the esophagus. In: Postlethwait RW, editor. Surgery of the esophagus. 2nd ed. Norwalk: Appleton Century Crofts; 1986. p. 129–59.
2. Cross F, Johnson G, Gerein A. Esophageal diverticula: associated neuromuscular changes in the esophagus. Arch Surg. 1961;83:525–33.
3. Debas HT, Payne WS, Cameron AJ, Carlson HC. Physiopathology of lower esophageal diverticulum and its implications for treatment. Surg Gynecol Obstet. 1980;151:593–600.
4. Roman S, Tutuian R. Esophageal hypertensive peristaltic disorders. Neurogastroenterol Motil. 2012;24(Suppl 1):32–9.
5. Tsuboi K, Mittal SK, Legner A, Yano F, Filipi CJ. Relationship between manometric findings and reported symptoms in nutcracker esophagus: insights gained from a review of 313 patients. J Gastroenterol. 2010;45:1033–8.
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