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Related Concept Videos

Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

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Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
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Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
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Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

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Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
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Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
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Esophageal Perforation-I: Introduction01:22

Esophageal Perforation-I: Introduction

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Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
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Midesophageal diverticulum with elevated intrabolus pressure: a case report.

Kaito Mihara1, Shigeru Tsunoda2, Tatsuto Nishigori1

  • 1Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.

Surgical Case Reports
|May 3, 2024
PubMed
Summary

Midesophageal diverticulum (M-ED) can stem from motility issues, even if not meeting Chicago classification criteria. Surgical myotomy can effectively treat M-ED and reduce intrabolus pressure, improving patient outcomes.

Keywords:
DiverticulumDysphagiaEsophagusMyotomyThoracoscopy

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Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology

Background:

  • Esophageal diverticula are often linked to esophageal motility disorders.
  • Midesophageal diverticulum (M-ED) is typically associated with inflammation, but motility disorders are emerging as a cause.
  • High-resolution manometry (HRM) is used for diagnosing esophageal motility disorders per the Chicago classification.

Purpose of the Study:

  • To report a case of M-ED with elevated intrabolus pressure (IBP) not meeting Chicago classification criteria.
  • To highlight the importance of recognizing M-ED in conjunction with HRM findings, even atypical ones.
  • To evaluate the efficacy of surgical intervention for M-ED and associated elevated IBP.

Main Methods:

  • Case presentation of a 71-year-old male with M-ED and dysphagia.
  • Diagnostic evaluation included high-resolution manometry (HRM) to assess esophageal pressures and motility.
  • Treatment involved thoracoscopic resection of M-ED and myotomy.

Main Results:

  • The patient presented with an 8-cm M-ED and multiple lower esophageal diverticula.
  • HRM showed median integrated relaxation pressure of 14.6 mmHg, distal latency of 6.4 s, and average maximum IBP of 35.7 mmHg.
  • Post-surgical intervention, symptoms resolved, and IBP normalized.

Conclusions:

  • Esophageal diverticulum should be considered alongside HRM findings, even when Chicago classification criteria for motility disorders are not fully met.
  • Myotomy is a valuable therapeutic option for M-ED when associated with elevated IBP.
  • Accurate diagnosis and tailored surgical treatment can effectively manage M-ED and related esophageal dysfunction.