Symptomatic esophageal diverticula are rare in infants and children [1].
We report a 6-year-old boy with esophageal diverticulum who presented to
us with dysphagia, frequent vomiting, and chest pain since one year of
age, mimicking a simple gastroesophageal reflux.
On physical examination, his growth was normal. A
barium esophagram showed a sac-shaped esophageal diverticulum arising from
the left side of the lower third of the esophagus (Fig 1).
Esophagoscopy demonstrated a broad-based esophageal diverticulum with
grossly normal mucosa. Surgery was recommended but his family refused. He
did not receive any medication. However, he changed his eating habits and
chewed solid food well before he swallowed it. One-year later, he still
vomited sometimes but had no dysphagia or chest pain.
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Fig. 1 The barium esophagram showed one diverticulum (arrow)
arising from the left side of the lower third of the esophagus.
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Esophageal diverticula are unusual small lesions that
are asymptomatic at first. As with our patient, retention of a food within
a diverticulum probably contributes to the progressive enlargement of the
pouch and may cause regurgitation or vomiting, dysphagia or chest pain
[1]. The mild and uncomplicated reflux-like symptom usually delays the
prompt diagnosis in children with esophageal diverticulum. Treatment is
generally reserved for symptomatic patients and surgery is the mainstay,
when nutritional or respiratory complications are present [2,3].
References
1. Steiner SJ, Cox EG, Gupta SK, Kleiman MB, Fitzgerald
JF. Esophageal diverticulum: a complication of histoplasmosis in children.
J Pediatr. 2005;146:426-8.
2. D’Ugo D, Cardillo G, Granone P, Coppola R,
Margaritora S, Picciocchi A. Esophageal diverticula: physiopathologi-cal
basis for surgical management. Eur J Cardiothorac Surg. 1992;6:330-4.
3. Kilic A, Schuchert MJ, Awais O, Luketich JD,
Landreneau RJ. Surgical management of epiphrenic diverticula in the
minimally invasive era. JSLS. 2009;13:160-4.