Midesophageal Pulsion Diverticulum Resulting From Hypercontractile (Jackhammer) Esophagus

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Esophageal Motility Disorders

Background:

• Jackhammer esophagus is a hypercontractile esophageal motility disorder.
• Midesophageal pulsion diverticula are rare and can cause dysphagia.
• The co-occurrence of these conditions is exceptionally uncommon.

Observation:

• A patient presented with significant dysphagia attributed to coexisting jackhammer esophagus and a midesophageal pulsion diverticulum.
• The patient's lower esophageal sphincter (LES) function was normal.

Findings:

• Successful surgical treatment was achieved using a thoracoscopic approach.
• The procedure included diverticulectomy and a long esophageal myotomy, crucially sparing the LES.
• This represents the first reported case of a midesophageal diverticulum associated with jackhammer esophagus.

Implications:

• The findings suggest a potential link between hypercontractile esophageal activity and the formation of midesophageal diverticula.
• For patients with normal LES function, a combined approach of diverticulectomy and LES-sparing myotomy appears effective.
• This case expands the understanding of rare esophageal motility disorders and their surgical management.