A Large Epiphrenic Esophageal Diverticulum Communicating with the Left Lower Lobe

Area of Science:

• Gastroenterology
• Thoracic Surgery
• Pulmonology

Background:

• Epiphrenic diverticula, outpouchings of the esophagus near the diaphragm, are rare and can lead to various complications.
• Complications include dysphagia, reflux, aspiration, and, rarely, fistula formation and massive bleeding.

Observation:

• A 54-year-old woman with a known epiphrenic diverticulum presented with massive hematemesis ten years after diagnosis.
• Imaging revealed a large 7.8 cm epiphrenic diverticulum with significant intradiverticular bleeding.
• Computed tomography demonstrated a fistula between the diverticulum and the left lower lobe of the lung, resulting in a pulmonary abscess.

Findings:

• The patient underwent transabdominal diverticulectomy and partial fundoplication.
• The pulmonary abscess was successfully managed with antibiotic therapy.
• The patient recovered without complications and was discharged 16 days post-operation, with a 7-month follow-up showing no adverse events.

Implications:

• This case underscores the potential for severe, life-threatening complications from epiphrenic diverticula, including fistula formation and massive hemorrhage.
• It highlights the importance of vigilant monitoring and timely surgical intervention for large or symptomatic epiphrenic diverticula.
• Successful management involves a multidisciplinary approach, combining surgical resection with appropriate medical treatment for associated complications like pulmonary abscesses.