A Case of Acute Mediastinitis due to Perforation of an Esophageal Epiphrenic Diverticulum during Follow-up of the Diverticulum

Abstract

Esophageal epiphrenic diverticulum is a rare condition and can be indicated surgery if it is associated with motor abnormalities of the esophagus and food regurgitation. Recently we have experienced a case of esophageal epiphrenic diverticulum in which the patient developed perforation of the esophageal diverticulum and acute mediastinitis which followed favorable clinical course after drainage followed by resection and reconstruction via a two-step approach.

The patient was a 68-year-old man who presented with a sensation of food sticking in the throat. He was found to have an esophageal epiphrenic diverticulum and was scheduled to undergo surgery. However, subjective symptoms disappeared, and we selected to observe his clinical course according to his hope. During observation, perforation of the esophageal epiphrenic diverticulum and acute mediastinitis occurred so that emergent laparoscopic trans-hiatal mediastinal drainage was performed. After the mediastinitis was subsided, thoracoscopic subtotal esophagectomy was performed. After the surgery he developed suture failure, but it was conservatively resolved. He was discharged on 35^th postoperative day.

Esophageal epiphrenic diverticulum often presents with regurgitation and other symptoms, but these symptoms can improve spontaneously with enlargement of the diverticulum, leading to be a high risk of causing perforation. In the treatment of perforation of the esophageal diverticulum associated with acute mediastinitis, the surgery through a two-step approach was useful.