Background: Mid-thoracic and lower-third esophageal diverticula are rare clinical conditions manifesting with dysphagia and regurgitation. In case of dysphagia endoscopic dilation of the esophagogastric junction may be employed to alleviate distal esophageal outflow resistance in patients unsuitable for surgical intervention. Laparoscopic or thoracoscopic diverticulectomy, with or without myotomy, may be considered for symptomatic patients fit for surgery. Diffuse esophageal diverticulosis (DED), however, is exceedingly rare, and its diagnostic evaluation and therapeutic management may be considerably more challenging than those of isolated esophageal diverticula because of the extensive structural involvement of the esophageal body. With the aim of illustrating the diagnostic assessment and therapeutic decision-making in this rare condition, we report a case of severe symptomatic DED treated by minimally invasive Ivor-Lewis esophagectomy. Case Description: A 74-year-old man presented with long-standing worsening dysphagia that evolved into absolute intolerance to oral intake, postprandial vomiting, and significant over six-month weight loss (14% of body weight). Upper endoscopy and contrast swallow study demonstrated DED characterized by multiple large, partially confluent diverticula involving the mid-thoracic and distal esophagus, causing marked tortuosity, contrast stasis, and delayed esophageal emptying. Upper endoscopy and computed tomography excluded malignancy. Given the severity of symptoms and extent of disease a minimally invasive Ivor-Lewis esophagectomy with Orringer anastomosis was performed. The postoperative course was uneventful. At 12-month follow-up the patient was asymptomatic with no dysphagia or regurgitation. Conclusions: Esophageal diverticula are rare and often associated with motility disorders. Although most patients are asymptomatic or respond to conservative management with endoscopic dilation, severe cases may lead to malnutrition, aspiration pneumonia, and disabling dysphagia with severe weight loss. Standard surgery addresses the diverticulum and the underlying motility disorder. However, in DED with significant esophageal structural damage, limited procedures may be ineffective. In carefully selected, physiologically fit patients, esophagectomy may represent an option. This case demonstrates that minimally invasive esophagectomy can achieve meaningful symptom relief and quality of life improvement.
Minimally invasive Ivor-Lewis esophagectomy for diffuse esophageal diverticulosis: a case report with video-vignette
Bonavina L.;
2026-01-01
Abstract
Background: Mid-thoracic and lower-third esophageal diverticula are rare clinical conditions manifesting with dysphagia and regurgitation. In case of dysphagia endoscopic dilation of the esophagogastric junction may be employed to alleviate distal esophageal outflow resistance in patients unsuitable for surgical intervention. Laparoscopic or thoracoscopic diverticulectomy, with or without myotomy, may be considered for symptomatic patients fit for surgery. Diffuse esophageal diverticulosis (DED), however, is exceedingly rare, and its diagnostic evaluation and therapeutic management may be considerably more challenging than those of isolated esophageal diverticula because of the extensive structural involvement of the esophageal body. With the aim of illustrating the diagnostic assessment and therapeutic decision-making in this rare condition, we report a case of severe symptomatic DED treated by minimally invasive Ivor-Lewis esophagectomy. Case Description: A 74-year-old man presented with long-standing worsening dysphagia that evolved into absolute intolerance to oral intake, postprandial vomiting, and significant over six-month weight loss (14% of body weight). Upper endoscopy and contrast swallow study demonstrated DED characterized by multiple large, partially confluent diverticula involving the mid-thoracic and distal esophagus, causing marked tortuosity, contrast stasis, and delayed esophageal emptying. Upper endoscopy and computed tomography excluded malignancy. Given the severity of symptoms and extent of disease a minimally invasive Ivor-Lewis esophagectomy with Orringer anastomosis was performed. The postoperative course was uneventful. At 12-month follow-up the patient was asymptomatic with no dysphagia or regurgitation. Conclusions: Esophageal diverticula are rare and often associated with motility disorders. Although most patients are asymptomatic or respond to conservative management with endoscopic dilation, severe cases may lead to malnutrition, aspiration pneumonia, and disabling dysphagia with severe weight loss. Standard surgery addresses the diverticulum and the underlying motility disorder. However, in DED with significant esophageal structural damage, limited procedures may be ineffective. In carefully selected, physiologically fit patients, esophagectomy may represent an option. This case demonstrates that minimally invasive esophagectomy can achieve meaningful symptom relief and quality of life improvement.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
