Esophagectomy for complications of esophageal intramural pseudodiverticulosis

• Published in: Diseases of the esophagus 2007-04, Vol.20 (2), p.178-182
• Main Authors: Thibodeau, M.‐P., Brigand, C., Ferraro, P., Martin, J., Duranceau, A.
• Format: Article
• Language: English
• Subjects: Abscess - etiology; Abscess - therapy; Anti-Bacterial Agents - therapeutic use; Candida albicans - isolation & purification; Candidiasis - diagnosis; Candidiasis - drug therapy; Diverticulosis, Esophageal - complications; Diverticulosis, Esophageal - diagnosis; Diverticulosis, Esophageal - surgery; Esophageal Stenosis - etiology; Esophageal Stenosis - therapy; Esophagectomy; Fistula - etiology; Fistula - therapy; Humans; Male; Mediastinal Diseases - etiology; Mediastinal Diseases - therapy; mediastinum; Middle Aged; pseudodiverticulosis; septic complication; Sputum - microbiology
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/j.1442-2050.2007.00666.x

This report describes the clinical course of a patient with complications of esophageal intramural pseudodiverticulosis. The condition led to fistulization and abscess formation in the mediastinum. The initial presentation was for the septic process and appropriate antibiotic therapy led to infection control while the abscess drained spontaneously back into the esophageal lumen. A long stricture affecting the distal half of the esophagus became evident after a few months and could not be managed by repeat dilatations. After appropriate preparation, subtotal esophagectomy was offered to the patient with an initial right thoracic approach followed by laparotomy and left cervical reconstruction. A total gastric tube was used for reconstruction and placed in a substernal position. An uneventful postoperative evolution led to normal swallowing comfort.