SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : DIVERTICULUM OF ESOPHAGUS (DIVERTICULUM OESOPHAGI) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. There are: traction diverticula formed from the action of thrust from the outside in inflammatory process, most of tuberculosis, lymph node, small size; pulseone from increased pressure inside pressure of the lump of food in a wall section that is not covered longitudinal muscle fibers during tonic contraction cricoid-pharyngeal sphincter and a - traction-pulseone.
The pathogenesis. At the location of diverticula are high (and pharyngeal pharyngeal-esophageal at a distance of 20 cm from the edge of the cutters for the most part pulseone) and the actual esophageal epibranchial - at the height of the bifurcation (IV - V thoracic vertebra), more traction, small size, epinephelinae - over cardia in the lower third of the thoracic esophagus - can reach a large size. Diverticula consist of thickened mucous membrane, often inflamed and even wounded.
Symptoms. Small traction diverticula do not produce symptoms. You can contact them food (periesophageal, perforation). For large diverticula gradually develops dysphagia, intermittent discomfort when swallowing, salivation, retching and vomiting, regurgitation, feeling of pressure in the neck or behind the sternum, sour, sometimes rotten, smell cough. When increasing the diverticulum grows dysphagia, sometimes delayed first pharynx, sometimes later, you receive a noise during the passage of liquid food, improve the permeability in the change of position of the body, swelling of the neck when eating, emptying diverticulum during compression of the neck, difficulty breathing, chest pain, radiating along the branches of the brachial plexus. Emaciation of the patient due to dysphagia reminds esophageal cancer,
Course and complications. The delay of food, especially in the diverticulum with a narrow inlet, is the source of the infection violates the circulation of blood and lymph, causing esophagitis, ulceration. The process usually progresses, it may cause hoarseness, perforation.
Recognition only by x-ray and esophagoscopy.
Conservative treatment (well crushed food, abundantly moistened with saliva or drink alkaline water and swallow them in the most convenient for the patient position) only effective with small diverticula. In other cases surgery.