[Intramural pseudodiverticulosis of the esophagus. Diagnosis on second look]

Case 1. A 56-year-old man had experienced increasing dysphagia for 6 months, accompanied by a weight loss of 20 kg. A stenosing oesophageal carcinoma was suspected. Case 2. A 82-year-old man had been suffering intermittently from nausea for some years but had maintained his weight (80 kg; height 173 cm). Endoscopy 4 months before this admission had revealed a duodenal ulcer; its treatment briefly improved the symptoms.

Endoscopy in case 1 detected a severe oesophageal stenosis which could not be passed, and its cause could not be ascertained despite biopsy, barium swallow and computed tomography. After bougie dilatation an endoscope was finally passed and the typical picture of oesophageal pseudodiverticulosis (OPD) seen. In case 2, endoscopy at first indicated only marked Candida oesophagitis. But after antimycotic treatment a second endoscopy revealed OPD. No treatment is known nor necessary since OPD causes no clinical symptoms unless there are complications.

OPD, a rare condition, presents in various ways, both in its symptoms and at endoscopy. In case of oesophageal stenosis of unknown cause or Candida oesophagitis repeat endoscopy my be necessary to establish the true diagnosis: OPD should be included in the differential diagnosis.