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Perrin MA, Graham DY, Larson SA. Dysphagia in a 75-Year-Old Male. Gastroenterology 2024; 167:e1-e5. [PMID: 38373637 DOI: 10.1053/j.gastro.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Michael A Perrin
- Department of Medicine, Baylor College of Medicine, Houston, Texas.
| | - David Y Graham
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Scott A Larson
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
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2
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Shintaku M. Esophageal intramural pseudodiverticulosis. World J Gastroenterol 2024; 30:137-145. [PMID: 38312118 PMCID: PMC10835521 DOI: 10.3748/wjg.v30.i2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a disease of unknown pathogenesis characterized by usually systemic, cystic dilatation of the excretory ducts of esophageal submucosal glands. In this article, I review the epidemiology, clinical manifestations, endoscopic findings, esophagographic findings, and histopathology of EIPD. I also discuss the etiology and possible pathogenesis of EIPD based on my experiences with this disease and a review of the literature. EIPD usually presents with dysphagia in middle-aged individuals. It is often complicated with secondary infections, most commonly candidiasis. On esophagography, EIPD is delineated as small, multiple, flask-shaped outward projections within the esophageal wall. In recent years, EIPD has been mainly diagnosed by endoscopic findings of multiple, localized, small mucosal depressions. The orifices of the "pseudodiverticula" periodically open and close, and excrete mucus onto the mucosal surface. On histopathological examination, the luminal surface of dilated ducts in EIPD is covered by multilayered, hyperplastic epithelial cells, but myoepithelial cells in the glandular acini are well preserved. Treatment of EIPD is usually symptomatic therapy, and prevention of the infectious complications is important. The etiology and pathogenesis of EIPD are largely unknown, but functional abnormalities of autonomic nerve fibers innervating the esophageal glands likely play an important role, since the structures of the glands are basically preserved in this disease.
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Affiliation(s)
- Masako Shintaku
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Hirakata 573-8511, Osaka, Japan
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3
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Elmdaah A, Moroni F. An Unexpected Finding During Oesophago-Gastro-Duodenoscopy in a Patient Presenting With Food Bolus Obstruction. Cureus 2023; 15:e50617. [PMID: 38226117 PMCID: PMC10788819 DOI: 10.7759/cureus.50617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
Oesophageal intraluminal pseudodiverticulosis is a rare benign condition of the oesophageal wall, with not many cases reported in the literature. Usually, patients present with dysphagia and food impaction in association with a proximal oesophageal stricture. Pathogenesis of the disease is not yet established; hence, it remains important to raise awareness about this distinctive pathology. Here, we present a case of a 62-year-old male admitted to Aberdeen Royal Infirmary, Scotland, UK, with a history of food bolus. Upper gastrointestinal endoscopy revealed food bolus impaction with underlying oesophageal pseudodiverticulosis in the distal two-thirds of the oesophagus.
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Affiliation(s)
- Ali Elmdaah
- Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, GBR
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4
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Kunimitsu A, Ujiie N, Sato C, Taniyama Y, Okamoto H, Fukutomi T, Ozawa Y, Ohnuma S, Unno M, Kamei T. Esophageal Intramural Pseudodiverticulosis Diagnosed by Combining Esophagogastroduodenoscopy, Esophagography, and High-resolution Manometry. Intern Med 2023; 62:1495-1499. [PMID: 36223924 PMCID: PMC10258114 DOI: 10.2169/internalmedicine.0337-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/04/2022] [Indexed: 04/07/2023] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a rare disease. A 78-year-old man with dysphagia presented to our hospital. The presence of diffuse esophageal spasm was suspected by his primary-care doctor. High-resolution manometry (HRM) showed no abnormal findings. The patient was diagnosed with EIPD and Candida esophagitis, by esophagogastroduodenoscopy (EGD) and esophagography. His symptoms improved after symptomatic treatment for Candida esophagitis with oral administration of an antifungal drug. EIPD should be considered in patients with dysphagia; EGD and esophagography should be performed when diagnosing EIPD.
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Affiliation(s)
- Atsushi Kunimitsu
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Naoto Ujiie
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Chiaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yusuke Taniyama
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Hiroshi Okamoto
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Toshiaki Fukutomi
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yohei Ozawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Shinobu Ohnuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Japan
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5
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Raza D, Mubashir M, Zia HA. Outpouching in the Esophagus: An Uncommon Endoscopic Finding of Esophageal Intramural Pseudodiverticulosis in the Absence of Esophageal Candidiasis. Cureus 2023; 15:e39805. [PMID: 37398731 PMCID: PMC10313527 DOI: 10.7759/cureus.39805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
We present a case of a 51-year-old female with a history of acquired immunodeficiency syndrome (AIDS) and medication non-compliance who experienced progressively worsening dysphagia to both solids and liquids over a three-month period. The patient underwent an esophagogastroduodenoscopy (EGD), which revealed multiple small pseudodiverticula without any other notable abnormalities. Subsequently, a barium esophagogram was performed, confirming the presence of multiple esophageal pseudodiverticula. Biopsies taken during the procedure showed chronic inflammatory changes, with no evidence of viral or fungal elements. In light of the patient's HIV history and the absence of esophageal candidiasis, the diagnosis of esophageal intramural pseudodiverticulosis (EIP) was made. The patient was initiated on highly active antiretroviral therapy (HAART) and received high-dose proton pump inhibitors (PPIs). Remarkably, the patient reported a complete resolution of her dysphagia symptoms during the follow-up visit. Risk factors associated with EIP include HIV infection, diabetes mellitus (DM), and esophageal candidiasis. To confirm the diagnosis, a barium esophagogram is considered the preferred imaging study. The management of EIP focuses on PPI therapy, the dilation of strictures if present, and addressing the underlying etiology. Given the association between EIP and esophageal malignancies, surveillance endoscopy may be recommended in these patients. This case highlights the importance of considering EIP as a potential cause of dysphagia, particularly in individuals with HIV/AIDS, even in the absence of esophageal candidiasis. Prompt diagnosis and appropriate management can lead to symptom resolution and improved quality of life for affected patients.
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Affiliation(s)
- Daniyal Raza
- Internal Medicine, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Maryam Mubashir
- Gastroenterology and Hepatology, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
| | - Hassaan A Zia
- Gastroenterology and Hepatology, Louisiana State University (LSU) Health Shreveport, Shreveport, USA
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6
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Veria S, Glosser LD, Lombardi CV, Javaid T, Ramadugu A. Symptomatic esophageal intramural pseudodiverticulosis without stricture: A case report. SAGE Open Med Case Rep 2023; 11:2050313X221140244. [PMID: 36814679 PMCID: PMC9940231 DOI: 10.1177/2050313x221140244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 11/03/2022] [Indexed: 02/19/2023] Open
Abstract
Esophageal intramural pseudodiverticulosis is a benign disease characterized by numerous, small outpouchings from the esophageal epithelium. Esophageal intramural pseudodiverticulosis has scarcely been reported with only 200-300 cases worldwide. The etiology of esophageal intramural pseudodiverticulosis is also unclear; however, there is an associated increased risk with diabetes mellitus, gastroesophageal reflux disease, esophageal candidiasis, and chronic alcohol and tobacco abuse. Esophageal intramural pseudodiverticulosis has a characteristic appearance on esophagogastroduodenoscopy. Treatment of esophageal intramural pseudodiverticulosis has historically been limited to symptom management with acid suppression, anti-fungal therapy, and endoscopic dilation in areas of stricture. This report is a case of a 52-year-old female status post two esophageal stricture repairs with dilation over prior 2 years, who presented with non-remitting solid food dysphagia and food impaction found to have esophageal intramural pseudodiverticulosis with concomitant jackhammer esophagus and esophageal candidiasis.
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Affiliation(s)
- Spiro Veria
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Logan D Glosser
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Conner V Lombardi
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
- Conner V Lombardi, College of Medicine and Life Sciences, The University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA.
| | - Toseef Javaid
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, USA
| | - Ajit Ramadugu
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, USA
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7
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Hentschel F. Chronic fibrosing esophagitis with diffuse esophageal intramural pseudo‐diverticulosis. JGH OPEN 2022; 6:287-291. [PMID: 35601128 PMCID: PMC9120889 DOI: 10.1002/jgh3.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/24/2022] [Accepted: 04/23/2022] [Indexed: 12/01/2022]
Abstract
Diffuse esophageal intramural pseudo‐diverticulosis (DEIPD) is a chronic fibrosing inflammation of the esophagus of unknown origin. Its name derives from the characteristic pseudo‐diverticula formed by dilated ducts of submucosal glands. With an assumed prevalence of approximately 5–50/100 000, DEIPD is more frequent than previously estimated. It preferentially affects men between 50 and 70 years of age with a history of alcohol and tobacco abuse. Key symptoms are chronic dysphagia and food impactions. Typical endoscopic findings are multiple small, longitudinally aligned pseudo‐diverticle openings and trachealization of the esophagus. Additionally, the usually gray mucosa may show a fine‐grained pattern of very small red dots that merge into a pink tint, called “faux uni pattern.” Once established, clinical symptoms and endoscopic changes persist throughout life. Although there is no known causal therapy, complications like bolus impactions, candida infections, or reflux can and should be treated.
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Affiliation(s)
- Florian Hentschel
- Department of Gastroenterology and Hepatology Brandenburg Medical School (Theodor Fontane) Brandenburg Germany
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8
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Shintaku M, Shintaku M, Torii I. Development of Epidermoid Metaplasia of the Mucosa in Association with Esophageal Intramural Pseudodiverticulosis and Candidiasis. Case Rep Gastroenterol 2021; 15:709-714. [PMID: 34594170 PMCID: PMC8436600 DOI: 10.1159/000518023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/11/2021] [Indexed: 12/14/2022] Open
Abstract
We report a case of epidermoid metaplasia of the esophageal mucosa that developed in a patient with a long history of esophageal intramural pseudodiverticulosis (EIPD) complicated by candidiasis. The patient, a 69-year-old man, had been treated for about 3 years for EIPD with candidiasis. After candidiasis improved, the development of epidermoid metaplasia of the esophageal mucosa was observed. It comprised longitudinally arranged, multiple, small, whitish flecks with a scaly appearance on the mucosa of the middle to lower esophagus, and pathological examination demonstrated several fine keratohyalin granules in superficial layers of the squamous epithelium. Six months later, candidiasis was almost cured, but these small flecks had slightly increased in size, and pathological examination demonstrated epidermoid metaplasia consisting of a thick, acellular keratin layer and well-developed granular layer beneath it. We considered that chronic candida esophagitis played the principal pathogenetic role in the development of epidermoid metaplasia. EIPD may have provided an environment suitable for the growth of fungi, and mucinous material contaminated by Candida and excreted from the orifices of EIPD may have irritated the mucosa and induced epidermoid metaplasia.
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Affiliation(s)
- Masako Shintaku
- Department of Gastroenterology, Japan Community Health care Organization, Hoshigaoka Medical Center, Hirakata, Japan
| | | | - Ikuko Torii
- Department of Diagnostic Pathology, Japan Community Health care Organization, Hoshigaoka Medical Center, Hirakata, Japan
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9
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Ali O, Asumu H, Kaur T, Mathew A, Kim R. A rare cause of dysphagia due to esophageal intramural pseudodiverticulosis: a case report and review of literature. BMC Gastroenterol 2020; 20:72. [PMID: 32178627 PMCID: PMC7074979 DOI: 10.1186/s12876-020-01209-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Esophageal intramural pseudodiverticulosis is an uncommon, idiopathic disorder characterized by multiple small outpouchings protruding from the esophageal lumen. Esophageal intramural pseudodiverticulosis is associated with conditions such as gastroesophageal reflux disease and diabetes mellitus, as well as emergent complications including pneumomediastinum. The most common presenting symptom is dysphagia with associated esophageal stricture formation. While the pathogenesis of EIP has yet to be determined, it is important to bring awareness to this unique disease with distinctive diagnostic findings and treatment options. CASE PRESENTATION In this case, we present a 62-year-old woman who suffered from dysphagia, an inability to tolerate a regular diet, and unintentional weight loss for several years prior to her diagnoses. She was diagnosed by esophagram and esophagogastroduodenoscopy to have esophageal intramural pseudodiverticulosis, complicated by severe stricture formation. Following treatment with sequential dilatation and maintenance H2-blocker therapy, she achieved significant symptomatic improvement. CONCLUSIONS This case highlights the importance of accurate identification and treatment of an uncommon cause of dysphagia, esophageal intramural pseudodiverticulosis. Treatment includes dilatational therapy, as successfully demonstrated in our patient. Furthermore, treatment is focused on optimizing medical management, as demonstrated in our patient with the addition of an H2-blocker for GERD, or addressing potentially serious underlying causes, such as carcinoma, with surgery.
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Affiliation(s)
- Osman Ali
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Hazel Asumu
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Tanisha Kaur
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Angelina Mathew
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Raymond Kim
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA.
- Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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10
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Sawada R, Oshikiri T, Nakamura T, Yamamoto M, Matsuda T, Sumi Y, Itoh T, Zen Y, Suzuki S, Kakeji Y. Mass-Forming Deep Pseudodiverticulosis of the Esophagus With 18F-Fluorodeoxyglucose Uptake. Ann Thorac Surg 2018; 106:e309-e311. [PMID: 29859150 DOI: 10.1016/j.athoracsur.2018.04.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/24/2018] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
Abstract
This report describes a case of esophageal intramural pseudodiverticulosis associated with an inflammatory esophageal mass with high 18F-fluorodeoxyglucose (FDG) uptake. A 48-year-old man presented with dysphagia caused by an esophageal stricture. Simultaneous positron emission tomography and magnetic resonance imaging showed an FDG-avid lesion in the lower esophagus. Because of suspected malignancy, the patient underwent subtotal esophagectomy. Histologic examination confirmed the diagnosis of an inflammatory tumor associated with esophageal pseudodiverticulosis. Unlike typical cases, this patient's pseudodiverticula involved both the submucosa and the muscularis propria. This case suggests that esophageal intramural pseudodiverticulosis can manifest with a tumorlike mass that may be FDG positive in response to associated inflammation.
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Affiliation(s)
- Ryuichiro Sawada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
| | - Taro Oshikiri
- Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tetsu Nakamura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Masashi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takeru Matsuda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yasuo Sumi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoh Zen
- Department of Diagnostic Pathology, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Satoshi Suzuki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshihiro Kakeji
- Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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11
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Menezes A, Goel A, Sam G. An Atypical Cause of a Typical Symptom. Gastroenterology 2016; 151:e3-4. [PMID: 27591422 DOI: 10.1053/j.gastro.2016.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/15/2016] [Accepted: 06/06/2016] [Indexed: 12/02/2022]
Affiliation(s)
| | | | - Gina Sam
- Mount Sinai Hospital, New York, New York
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12
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A Treatment Option for Esophageal Intramural Pseudodiverticulosis. ACG Case Rep J 2014; 1:134-6. [PMID: 26157852 PMCID: PMC4435313 DOI: 10.14309/crj.2014.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/18/2014] [Indexed: 12/15/2022] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition often presenting with esophageal strictures. Treatment is often limited to endoscopic dilatation and treatment of the underlying esophageal pathology. We present a case of a patient with longstanding GERD on famotidine (she experienced anaphylaxis with proton pump inhibitors [PPIs]) who presented with dysphagia and weight loss. Work-up revealed a diagnosis of EIPD with a 5-mm mid-esophageal stricture. Therapy with dilatation was unsuccessful until the addition of sucralfate, after which dilatation was successful and symptoms resolved. In patients who are unable to take PPIs, the addition of sucralfate may enhance the success of dilatations of esophageal strictures and EIPD.
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13
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Majumder S, Coash M, Muralidharan V. Esophageal pseudodiverticulosis presenting with massive gastrointestinal bleed. Dig Endosc 2012; 24:383. [PMID: 22925299 DOI: 10.1111/j.1443-1661.2012.01247.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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14
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Chiba T, Iijima K, Koike T, Uno K, Asano N, Shimosegawa T. A case of severe esophageal intramural pseudodiverticulosis whose symptoms were ameliorated by oral administration of anti-fungal medicine. Case Rep Gastroenterol 2012; 6:103-110. [PMID: 22619654 PMCID: PMC3355650 DOI: 10.1159/000336846] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a rare disease of unknown etiology that displays multiple pseudodiverticula radiologically, leading to benign esophageal stricture. Dysphagia, which sometimes slowly progresses, is the main symptom in the majority of cases. We here report a 59-year-old male EIPD patient who suffered from severe dysphagia. Radiography and endoscopy of this patient disclosed a severe constriction in the upper thoracic esophagus. Although we tried several endoscopic procedures including frequent endoscopic balloon dilatation (EBD), the effect was very limited and his dysphagia relapsed shortly after the treatments. During the procedures, we noticed some white, thick, creamy liquid emerging from the orifices of EIPD, and PAS staining of biopsy specimens revealed infection with Candida albicans. Hence, the patient was given anti-fungal medicine in addition to EBD. The additional treatment with anti-fungal medicine dramatically improved his symptoms and the esophageal constriction. This case suggests that anti-fungal treatment is an effective first-line therapy even against a severe form of esophageal constriction in EIPD.
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Affiliation(s)
| | - Katsunori Iijima
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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15
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Shintaku M, Nishida T, Shiomi K, Shintaku M. Active opening and closing movements of the orifices of esophageal intramural pseudodiverticulosis. Gastrointest Endosc 2011; 74:1420-2. [PMID: 21295301 DOI: 10.1016/j.gie.2010.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 12/02/2010] [Indexed: 02/08/2023]
Affiliation(s)
- Masako Shintaku
- Department of Internal Medicine, Otokoyama Hospital, Yawata, Kyoto, Japan
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16
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Chon YE, Hwang S, Jung KS, Lee HJ, Lee SG, Shin SK, Lee YC. A case of esophageal intramural pseudodiverticulosis. Gut Liver 2011; 5:93-5. [PMID: 21461080 DOI: 10.5009/gnl.2011.5.1.93] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 03/20/2010] [Indexed: 11/04/2022] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIP) is a rare benign disease that is characterized by multiple tiny flask-shaped outpouching lesions of the esophageal wall. The etiology is unknown, but the pathologic findings include dilatation of excretory ducts of submucosal glands. The predominant symptom is dysphagia, and esophageal stricture occurs frequently. Diseases such as diabetes mellitus, esophageal candidiasis, gastroesophageal reflux disease, and chronic alcoholism are often combined. Since most EIP cases are benign, the mainstream treatment is symptom relief by endoscopic dilatation or medical treatment of accompanied diseases. This report describes the case of a 68-year-old male patient who suffered from chest tightness for 2 months and was diagnosed with EIP. This symptom disappeared after 2 months of medical treatment, and the patient is now being regularly followed up.
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Affiliation(s)
- Young Eun Chon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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17
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Baldinger A, Kranz A. A rare esophageal disorder. Gastroenterology 2011; 140:e7-8. [PMID: 21185421 DOI: 10.1053/j.gastro.2010.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/27/2010] [Indexed: 12/02/2022]
Affiliation(s)
- Anja Baldinger
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
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18
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Abstract
CONTEXT The pathologist plays the leading role in distinguishing pseudoneoplasms from truly neoplastic lesions in the gastrointestinal tract. OBJECTIVE This review was conducted to heighten awareness of pseudoneoplasms, to help differentiate among the various types of pseudoneoplasms, and to help distinguish pseudoneoplasms from malignancies. DATA SOURCES This review is based on the medical literature on pseudoneoplasms in MEDLINE and the authors' own experiences. Reference lists of retrieved articles were also reviewed to identify additional articles. CONCLUSIONS A classification of pseudoneoplasms, according to the mechanism of injury to the gastrointestinal tract, morphologic patterns, and heterotopia, may be useful in providing a diagnostic framework in which ancillary techniques often have a diagnostic role. Several pseudoneoplasms may be closely associated with true neoplasms (eg, malakoplakia, prolapsetype lesions) because of the nonspecific nature of the response of the intestine to injury.
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19
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Engel MA, Raithel M, Amann K, Greess H, Hahn EG, Konturek PC. Rare coincidence of eosinophilic esophagitis with esophageal stenosis and intramural pseudodiverticulosis. Dig Liver Dis 2008; 40:700-6. [PMID: 17643358 DOI: 10.1016/j.dld.2007.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 04/10/2007] [Accepted: 04/23/2007] [Indexed: 12/11/2022]
Abstract
We describe the first detailed case of eosinophilic esophagitis associated with esophageal intramural pseudodiverticulosis and gastro-esophageal reflux disease in a 24-year-old man, who suffered from recurrent dysphagia since the age of 3 years. He presented with symptoms of dysphagia, food impaction and malnutrition. An esophagogram revealed a high-grade stenosis in the proximal part of the esophagus. Histological evaluation of esophageal mucosal biopsies demonstrated more than 20 eosinophil granulocytes per high power field, indicative of eosinophilic esophagitis. Additionally, esophago-gastro-duodenoscopy showed pseudodiverticulosis in the distal portion of the esophagus. A therapeutic regimen consisting of topical steroid intake, antihistamines, proton-pump-inhibition and specific food avoidance led to significant clinical improvement within 6 weeks.
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Affiliation(s)
- M A Engel
- First Department of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany.
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20
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Thibodeau MP, Brigand C, Ferraro P, Martin J, Duranceau A. Esophagectomy for complications of esophageal intramural pseudodiverticulosis. Dis Esophagus 2007; 20:178-82. [PMID: 17439604 DOI: 10.1111/j.1442-2050.2007.00666.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- M-P Thibodeau
- Department of Surgery, Université de Montréal, Division of Thoracic Surgery, Center hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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21
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Attila T, Marcon NE. Esophageal intramural pseudodiverticulosis with food impaction. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2006; 20:37-8. [PMID: 16432558 PMCID: PMC2538963 DOI: 10.1155/2006/373264] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Esophageal intramural pseudodiverticulosis is a rare condition of unknown etiology originally described in 1960. It is characterized by multiple, flask-shaped outpouchings of pinhead size in the wall of the esophagus. Very small outpouchings on endoscopy and tiny collections of barium outside of the esophagus wall on esophagography are typical diagnostic findings. During the era of widespread endoscopic and radiological evaluation of esophageal disorders, approximately 200 cases were published in the literature. A 52-year-old man with esophageal intramural pseudodiverticulosis with food impaction is reported. The patient's symptoms of dysphagia resolved with endoscopic dilations and proton pump inhibitor therapy.
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Affiliation(s)
| | - Norman E Marcon
- Correspondence and reprints: Dr Norman E Marcon, St Michael’s Hospital, 16-062 Cardinal Carter Wing, 30 Bond Street, Toronto, Ontario M5B 1W8. Telephone 416-864-3092, fax 416-864-5993, e-mail
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22
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23
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Chen L, Walser EM, Schnadig V. Fatal hemorrhage secondary to ulcerated epiphrenic pseudodiverticulum. Arch Pathol Lab Med 2006; 130:867-70. [PMID: 16740042 DOI: 10.5858/2006-130-867-fhstue] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 47-year-old man was found unconscious after experiencing severe hematemesis. He had a history of alcohol abuse, hepatic cirrhosis, and previous episodes of gastrointestinal bleeding. Imaging studies indicated that the left gastric artery was the probable source of bleeding. A severe coagulopathy was also noted clinically. Angiographic embolization of the left gastric artery failed to staunch bleeding, and the patient died shortly after admission. Autopsy demonstrated a large, ulcerated epiphrenic esophageal pseudodiverticulum, the base of which was in close proximity to an esophageal branch of the left gastric artery. Cystic dilatation of adjacent esophageal submucosal glands was also seen. Gelatin embolic material, without associated thrombus formation, was found within the left gastric artery. Esophageal pseudodiverticulosis is an uncommon disorder that may be associated with dysphagia, stricture, and odynophagia. Bleeding and perforation are very rare complications. This case may be the first fatality proven by autopsy to be secondary to esophageal pseudodiverticulosis.
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Affiliation(s)
- Lei Chen
- Department of Cytopathology, The University of Texas Medical Branch, Galveston, TX 77555-0548, USA
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24
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DeVault KR, Cernigliaro JG. Esophageal Intramural Pseudodiverticulosis. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2003; 6:71-73. [PMID: 12521574 DOI: 10.1007/s11938-003-0035-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is an uncommon esophageal abnormality that is best diagnosed with a barium esophagram. The disorder is usually associated with other esophageal pathology, including strictures, motility disturbances, and other conditions that are outlined later. There is no specific treatment (either surgical or medical) for EIPD itself, and treatment should be directed at the underlying, associated conditions. If this condition is diagnosed on a barium study, endoscopy usually is needed to treat an associated stricture or to diagnose an associated inflammatory condition (particularly acid reflux and esophageal infections). Thus, endoscopy and barium studies are critical to guide the management of this condition.
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Affiliation(s)
- Kenneth R. DeVault
- Department of Medicine and Radiology, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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25
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Elabsi M, Echarrab M, Oudanane M, el Ounani M, Chkoff R, Zizi A. [Intramural pseudodiverticulosis of the esophagus. A case report and review of the literature]. ANNALES DE CHIRURGIE 2002; 127:637-40. [PMID: 12491641 DOI: 10.1016/s0003-3944(02)00842-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Oesophageal intramural pseudodiverticulosis is a very rare cause of dysphasia. This work reports the observation of a 42 year-man who presented with dysphasia; Diagnosis was established by baryum meal. The patient underwent an oesophagectomy because of failure of endoscopic dilatation. Pathologic examination revealed characteristic lesions of esophageal pseudodiverticulosis, with fissures between the lumen and sero-mucosal glands located in the oesophageal wall and containing Candida spores. By means of a review of the relevant literature, etiopathogenesis, diagnosis and treatment of oesophageal intramural pseudodiverticulosis are discussed.
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Affiliation(s)
- M Elabsi
- Service des urgences chirurgicales viscérales, CHU Ibn Sina, hôpital Avicenne, Rabat, Maroc.
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26
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Hahne M, Schilling D, Arnold JC, Riemann JF. Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding. J Clin Gastroenterol 2001; 33:378-82. [PMID: 11606853 DOI: 10.1097/00004836-200111000-00007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Esophageal intramural pseudodiverticulosis (EIP) is a rare condition manifested by multiple, flask-shaped outpouchings in the wall of the esophagus, which represent dilated excretory ducts of esophageal mucous glands. STUDY Five patients with EIP were evaluated with regard to symptoms and concomitant diseases, as well as endoscopic, radiologic, and manometric findings. RESULTS Primary clinical symptoms reported by the five patients (three men and two women; age range, 59-72 years) were increasing dysphagia ( n = 3), upper gastrointestinal bleeding ( n = 1), and no symptoms ( n = 1). Concomitant diseases were chronic alcoholism ( n = 3), diabetes mellitus ( n = 1), and reflux esophagitis ( n = 1). Primary diagnosis was made endoscopically in all cases. Endoscopic findings other than pseudodiverticula were esophageal webs ( n = 2) and proximal esophageal stenoses ( n = 4). The typical radiologic findings were detectable in two patients, pathologic manometric findings were seen in only one patient. The authors treated the concomitant diseases and performed endoscopic dilatations of esophageal stenoses. One case with initial bleeding from an associated web is described in detail. According to our knowledge, this is the first publication of a case of EIP-associated bleeding. CONCLUSION Esophageal intramural pseudodiverticulosis is a differential diagnosis in cases of dysphagia and/or esophageal strictures if no other causes are found. The authors think that endoscopy is the method of choice for establishing the diagnosis.
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Affiliation(s)
- M Hahne
- Department of Gastroenterology, Klinikum der Stadt Ludwigshafen gGmbH, Academic Teaching Hospital of the University of Mainz, Germany.
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27
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Solomon NS, Berseth CL, Braverman RM, Munden MM, Ferry GD. Infantile esophageal intramural pseudodiverticulosis. J Pediatr Gastroenterol Nutr 2000; 31:76-9. [PMID: 10896076 DOI: 10.1097/00005176-200007000-00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- N S Solomon
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA
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28
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Freud E, Golinsky D, Ziv N, Mor C, Zahavi I, Zer M. Esophageal intramural pseudodiverticulosis: a congenital or acquired condition? J Pediatr Gastroenterol Nutr 1997; 24:602-7. [PMID: 9161959 DOI: 10.1097/00005176-199705000-00020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- E Freud
- Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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29
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Guccion JG, Ortega LG. Trichomoniasis complicating esophageal intramural pseudodiverticulosis: diagnosis by transmission electron microscopy. Ultrastruct Pathol 1996; 20:101-7. [PMID: 8882356 DOI: 10.3109/01913129609016305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 58-year-old African-American man presented with a progressive esophageal stricture of unknown etiology complicated by esophageal candidiasis, broncho-esophageal fistula, four episodes of aspiration pneumonia, and a 40-lb weight loss. He ultimately required an esophagectomy. Pathologic examination showed marked thickening of the esophageal wall by submucosal pseudodiverticula typical of esophageal intramural pseudodiverticulosis (EIPD) and extensive mucosal and submucosal chronic inflammation and fibrosis. Small, oval cells with ill-defined nuclei were present in lumens of some pseudodiverticula, light microscopically. Their exact nature could not be determined by light microscopy. The diagnosis of trichomoniasis became apparent only after transmission electron microscopic study of these cells demonstrated characteristic features of trichomonad protozoa. These included four anteriorly placed flagella with kinetosomes, a recurrent flagellum associated with an undulating membrane, a costa, a peltar-axostylar complex, and a small Golgi body with parabasal filaments. This case of EIPD is unusual in that the associated broncho-esophageal fistula and trichomoniasis have not been previously reported as complications of EIPD.
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Affiliation(s)
- J G Guccion
- Pathology and Laboratory Medicine Service, Department of Veterans Affairs Medical Center, Washington, DC 20422, USA
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30
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Hoshika K, Inoue S, Mizuno M, Iida M, Shimizu M. Endoscopic detection of ectopic multiple minute sebaceous glands in the esophagus. Report of a case and review of the literature. Dig Dis Sci 1995; 40:287-90. [PMID: 7851191 DOI: 10.1007/bf02065411] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This case report describes a patient with a rare form of ectopic sebaceous glands. The patient was a 53-year-old woman complaining of prolapse of a polyp through the anus who was admitted for polypectomy of the rectal polyp. After polypectomy, esophagogastroduodenoscopy was performed to detect other lesions. Although she had no symptoms from an upper gastrointestinal series, such as dysphagia, heartburn, or epigastric pain, multiple yellow rounded elevated lesions arranged in rows, 0.5 mm in diameter and more than 100 in number were observed in the middle and lower esophagus. Histological examination of the biopsied specimens taken from the lesions endoscopically revealed a structure with the characteristics of a sebaceous gland including an excretory duct.
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Affiliation(s)
- K Hoshika
- Department of Medicine, Kawasaki Medical School, Kurashiki, Japan
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31
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Mahajan SK, Warshauer DM, Bozymski EM. Esophageal intramural pseudo-diverticulosis: endoscopic and radiologic correlation. Gastrointest Endosc 1993; 39:565-7. [PMID: 8365611 DOI: 10.1016/s0016-5107(93)70175-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- S K Mahajan
- Division of Gastroenterology, University of North Carolina, Chapel Hill 27599-7510
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32
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Solomon DJ, Kottler RE. Duodenal intramural pseudodiverticulosis. GASTROINTESTINAL RADIOLOGY 1992; 17:217-9. [PMID: 1612305 DOI: 10.1007/bf01888552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although esophageal intramural pseudodiverticulosis is well described, similar pathology has not been demonstrated elsewhere in the gastrointestinal tract. Three cases are reported with identical changes in the duodenum, one of which had simultaneous esophageal involvement. All three patients were alcohol abusers.
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Affiliation(s)
- D J Solomon
- Department of Radiology, University of Cape Town/Groote Schuur Hospital, South Africa
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33
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Kataoka H, Higa T, Koono M. An autopsy case report of diffuse esophageal intramural pseudodiverticulosis. ACTA PATHOLOGICA JAPONICA 1992; 42:837-40. [PMID: 1471532 DOI: 10.1111/j.1440-1827.1992.tb01886.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case report of diffuse esophageal intramural pseudodiverticulosis (EIPD) we encountered at autopsy is described. The pseudodiverticula represented dilated excretory ducts of esophageal submucosal glands with squamous metaplasia of the epithelium. They contained keratin flakes, mucin and/or inflammatory cells which were mainly neutrophils. Submucosal chronic inflammation surrounding the glands was prominent. The findings suggested that the ductal dilatation resulted from obstruction of the ducts by inflammatory material, mucus and desquamated epithelium. To the best of our knowledge, this is the first autopsy report of diffuse EIPD in Japan.
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Affiliation(s)
- H Kataoka
- Second Department of Pathology, Miyazaki Medical College, Japan
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34
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Datubo-Brown DD, Katchy KO, Gogo-Abite MR. Fatal haematemesis in childhood associated with aorto-oesophageal fistula. ANNALS OF TROPICAL PAEDIATRICS 1989; 9:182-3. [PMID: 2475067 DOI: 10.1080/02724936.1989.11748627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A case of fatal haematemesis associated with a non-traumatic, non-tuberculous aorto-oesophageal fistula in a 9-year-old Nigerian boy is presented. Autopsy revealed two inflamed and ulcerated mild-oesophageal pulsion diverticula, one of which had eroded into the right pleura as a sinus track. The second diverticulum had perforated and caused mediastinitis and eventually aorto-oesophageal fistula which led to the fatal haematemesis. A mild chest injury is seen as a precipitating factor of the haematemesis and not the initiator of the pathology.
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Affiliation(s)
- D D Datubo-Brown
- Department of Surgery, College of Health Sciences, University of Port Harcourt, Nigeria
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35
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36
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Medeiros LJ, Doos WG, Balogh K. Esophageal intramural pseudodiverticulosis: a report of two cases with analysis of similar, less extensive changes in "normal" autopsy esophagi. Hum Pathol 1988; 19:928-31. [PMID: 3136073 DOI: 10.1016/s0046-8177(88)80008-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is an uncommon cause of dysphagia. In this report, we describe two cases we encountered at autopsy. In both cases, the pseudodiverticula represented dilated excretory ducts of submucosal mucous glands. In addition, we retrospectively examined histologic sections of esophagus taken randomly from 100 autopsies, and prospectively studied 20 esophagi in a standardized fashion. Our findings suggest that the early pathologic changes of EIPD are more common than is appreciated in the literature. We found submucosal chronic inflammation surrounding mucous glands in more than 60% of esophagi at autopsy. Excretory duct dilatation and small pseudodiverticula were also commonly found, their prevalence related to the number of sections of esophagus studied. The finding of chronic inflammation associated with the earliest degrees of duct dilatation and pseudodiverticula formation suggests that inflammation may play a role in the etiology of this disorder.
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Affiliation(s)
- L J Medeiros
- Department of Pathology, New England Deaconess Hospital, Boston, MA 02215
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37
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Hopwood D, Coghill G, Sanders DS. Human oesophageal submucosal glands. Their detection mucin, enzyme and secretory protein content. HISTOCHEMISTRY 1986; 86:107-12. [PMID: 2432035 DOI: 10.1007/bf00492353] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Human oesophageal submucosal glands may be regularly demonstrated by first exposing the oesophageal lumen to toluidine blue which reveals the duct ostia. Four types of cell were identified in the glands - mucous, subsidiary or serous, myoepithelial and oncocytes. The mucous cell contained neutral, sialated and sulphated mucins. The subsidiary cells held smaller amounts of neutral and sialated mucin, plus fucosyl residues. No lipids were detectable histochemically. ATP-ase and alkaline phosphatase were shown in the capillary endothelium. The duct epithelium showed some nonspecific esterase activity not sensitive to E 600. By immunoperoxidase techniques, the duct epithelium was shown to be rich in cytokeratin. The subsidiary cells contained lysozyme, CEA and pepsinogen. B lymphocytes composed most of the periductular lymphoid aggregates, although some T cells were found there and also intraepithelial and subepithelial in relation to the stratified squamous epithelium lining the oesophagus. Langerhans' cells were also demonstrated as intraepithelial by several techniques.
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38
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Abstract
Twelve cases of oesophageal intramural pseudodiverticulosis are described and the findings in 85 previously reported cases are reviewed. The condition occurs in all age groups, predominantly in the sixth and seventh decades, with a slight predilection for males. The characteristic radiographic appearance is of multiple flask shaped outpouchings of 1-4 mm with narrow necks communicating with the oesophageal lumen. The source of the pseudodiverticula has been shown to be pathologically dilated excretory ducts of the submucous glands due to chronic submucosal inflammation. The distribution was segmental in 57 cases (59%) and diffuse in 40 (41%). Dysphagia is the main symptom and was found in 85 cases (88%); 88 cases out of 97 had radiological narrowing of the oesophagus; of these, 39 (44%) were in the upper oesophagus, 20 (23%) in the middle oesophagus, and 29 (33%) in the lower oesophagus. Treatment is directed towards management of the associated disorder, as the diverticula themselves rarely cause problems.
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39
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Murney RG, Linne JH, Curtis J. High-amplitude peristaltic contractions in a patient with esophageal intramural pseudodiverticulosis. Dig Dis Sci 1983; 28:843-7. [PMID: 6411438 DOI: 10.1007/bf01296908] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In their initial radiographic description of esophageal intramural pseudodiverticulosis (EIP) in 1960, Mendl and coworkers suggested that elevated esophageal intraluminal pressure might be etiologically important. Chronic inflammation and moniliasis have also been implicated. A patient is reported with EIP and a primary esophageal motility disorder characterized by esophageal contractions of increased amplitude and duration. Features confusing the interpretation of esophageal motor abnormalities in previously reported cases, such as diabetes mellitus, fungal esophagitis, and stricture formation, were not present in this case.
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40
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Brühlmann WF, Zollikofer CL, Maranta E, Hefti ML, Bivetti J, Giger M, Wellauer J, Blum AL. Intramural pseudodiverticulosis of the esophagus: report of seven cases and literature review. GASTROINTESTINAL RADIOLOGY 1981; 6:199-208. [PMID: 6796452 DOI: 10.1007/bf01890250] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Seven cases of esophageal intramural pseudodiverticulosis (EIPD) are presented and compared with 46 cases previously reported. EIPD is mainly a disease of older age with a 3:2 predominance of male patients. The radiologic appearance of EIPD shows great variation in localization and severity of visible changes. Radiologic examination is far more sensitive than endoscopy in diagnosing EIPD. The most effective therapy for EIPD is dilatation of strictures, leading to amelioration or disappearance of symptoms in over 90% of cases. Visible pseudodiverticula may persist after therapy, even in symptom-free patients.
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41
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Cho SR, Sanders MM, Turner MA, Liu CI, Kipreos BE. Esophageal intramural pseudodiverticulosis. GASTROINTESTINAL RADIOLOGY 1981; 6:9-16. [PMID: 6790328 DOI: 10.1007/bf01890214] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Esophageal intramural pseudodiverticulosis (EIP) is a rare condition of unknown etiology. It is characterized by multiple, small, flaskshaped outpouchings in the esophageal wall. Involvement may be segmental or diffuse. Since this entity was first reported in 1960, there have been 43 cases described in the English literature. These cases are reviewed and six additional cases are reported with emphasis on clinical and radiographic parameters of this entity.
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42
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Muhletaler CA, Lams PM, Johnson AC. Occurrence of oesophageal intramural pseudodiverticulosis in patients with pre-existing benign oesophageal stricture. Br J Radiol 1980; 53:299-303. [PMID: 6769530 DOI: 10.1259/0007-1285-53-628-299] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Five patients with benign oesophageal stricture are described who subsequently developed oesophageal intramural pseudodiverticulosis. Stricture was due to reflux oesophagitis in three patients and to lye ingestion in two. The minimum time between diagnosis of stricture and recognition of pseudodiverticulosis was two years. Most authors regard chronic inflammation as the initiating cause of pseudodiverticulosis. Although stricture is common, it generally occurs as part of the disease process and has not been regarded as a cause of the disorder. In our patients it is suggested that chronic inflammation due to stasis above a stricture, was the cause of pseudodiverticulosis. Out of the 36 cases of oesophageal intramural pseudodiverticulosis already reported, we could find only one patient in whom this sequence of events occurred.
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43
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Abstract
Intramural pseudodiverticulosis of the esophagus is a rare benign disease, developing most frequently in older males, but occurring in both sexes, at all ages. In some patients symptoms from early childhood suggest congenital origin. The characteristic appearance of "pinhead" outpouching from the lumen of the esophagus is seen with contrast esophagram. The major symptom is dysphagia with episodic exacerbations, often with foreign body lodgement. The pseudodiverticula are formed by abnormally dilated adnexal glands and ducts which lie in the submucosa of the esophagus. Secondary infection, most commonly monilial, is the rule, and surrounding inflammatory infiltration may progress to submucosal fibrosis and stenosis. Treatment with dilatation and appropriate antibiotics usually produces rapid relief. Prognosis is good.
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44
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Fromkes J, Thomas FB, Mekhjian H, Caldwell JH, Johnson JC. Esophageal intramural pseudodiverticulosis. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1977; 22:690-700. [PMID: 406782 DOI: 10.1007/bf01078348] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Three cases of esophageal intramural pseudodiverticulosis (EIP) are described and the literature reviewed. We conclude that EIP is an inflammatory disease of unknown etiology characterized by dilatation of the esophageal submucosal glandular elements. The classic radiographic picture which is that of collar-button-shaped outpouchings projecting in a perpendicular fashion from the luminal surface is mainly related to dilatation in the glandular ductal system. It is usually diagnosed in the sixth and seventh decades, but all ages may be affected. Dysphagia is a very common but not universal symptom of the disease process. Approximately one third of these patients have diabetes mellitus. Strictures of the esophagus are frequently seen, and varying degrees of esophagitis may be manifest endoscopically. Esophageal motility disturbances are common and may be severe. Candida infestation with and without tissue invasion has been seen in a number of patients and should be searched for in all cases of EIP.
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