Editing Oesophageal diverticulum (section)

== '''Mid-oesophageal diverticula''' ==

* Anatomy
** Typically seen on the right      due to an overabundance of structures in the mid-thoracic region on the      left
* Pathophysiology
** Traction diverticula
** Historically mostly TB
** Now more commonly caused by      histoplasmosis and resultant fibrosing mediastinitis
** Some may also be caused by a      primary motility disorder
* Presentation
** Mostly asymptomatic
** Often incidentally found
** Can get dysphagia, chest      pain and regurgitation
** Can present with chronic      cough or haemoptysis from a bronchoesophageal fistula
* Diagnosis
** Barium swallow
** CT scan essential
** Gastroscopy as part of      workup to rule out mucosal abnormalities
***
** Manometric studies highly      recommended by Sabiston's to exclude a primary motility disorder -      aetiology will determine treatment
* Management
** Diverticula <2cm can be      observed
** Asymptomatic patients with      inflamed mediastinal lymph nodes - treat underlying cause
** Symptomatic or >2cm      diverticula - surgery
*** Diverticulopexy to thoracic       vertebral fascia if it has a wide mouth and rests close to the spine
*** Diverticulectomy if       anatomically favourable - take care not to narrow oesophageal lumen
** Severe chest pain or      dysphagia and a documented motor abnormality - long oesophagomyotomy
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