What causes esophageal diverticulum?

Introduction] Pharyngeal esophageal diverticulum is often not caused by a single factor, but mostly due to achalasia of the cricopharyngeal muscle and esophageal muscle or other motor abnormalities, resulting in mucosal bulge and diverticulum on the basis of the above anatomy. Supradiaphragmatic diverticulum is also a bulging diverticulum, and the wall of the diverticulum has only a mucosal layer and a submucosal layer, and there are few muscle dimensions. Most of the literature reports that most supraphrenic diverticulums are associated with esophageal motor dysfunction, hiatal hernia, and esophagus.

Recommendation: Definition: The esophageal wall protrudes outwards in a localized manner, forming a blind pocket with complete epithelium that communicates with the esophageal lumen, which is mostly acquired, and congenital diverticula is rare.

Classification: It is divided into three categories according to the location and mechanism of occurrence: (1) Pharyngeal esophageal diverticulum: occurs at the pharyngeal esophageal junction, also known as Zenker's diverticulum, and its occurrence is related to pharyngeal esophageal muscle dysmotility.

Slow cricopharyngeal achalhale increases intraesophageal pressure and is associated with weakness in the local muscle anatomy. （2）

Middle esophageal diverticulum.

It is mostly located in the middle of the tracheal demarcation level, and is often caused by chronic inflammation and adhesion of the tissues around the mediastinum and scar tissue, and is mostly caused by tuberculous inflammation of the hilum or mediastinal lymph nodes. (3) Supraphragmatic diverticulum:

It usually occurs on the right side of the esophagus 5 to 10 cm above the diaphragm, and its formation may be related to the increase of pressure in the esophageal lumen due to functional or mechanical obstruction of the lower esophagus, which causes the esophageal mucosa to protrude through the weak area of the esophageal muscle. Pseudodiverticulum—pharyngeal esophageal diverticulum and supraphrenic diverticulum. It protrudes from the blind pouch and is only the esophageal mucosa rather than the full thickness of the esophagus, which is also called a bulging diverticulum.

True diverticulum - midesophageal diverticulum. Its protruding blind pocket contains the entire thickness of the esophageal wall.

Clinical symptoms: related to the location of the diverticulum, the size of the internal orifice, the presence or absence of food retention or inflammation, complications, etc., and respiratory symptoms may occur if the contents reflux. (1) Pharyngeal esophageal diverticulum: Slowly progressive dysphagia.

A sound can be heard when squeezing the neck or swallowing, and the regurgitation is usually freshly swallowed food with no bitter and sour taste. (2) Middle esophageal diverticulum: Because the internal orifice is large, it is conducive to drainage and there is little food retention, so it is not easy to produce symptoms, and occasionally it is difficult to swallow or swallow.

Occasionally, local abscesses or fistulas may be present. (3) Supraphrenic diverticulum: mild symptoms, occasional dyspepsia or dysphagia.

Diagnostic methods: esophagography, esophagoscopy, and esophageal function tests.

**: Smaller, asymptomatic diverticula may be treated without surgery**. Mild symptoms can be medically conservative**. Larger diverticulums with significant symptoms should be surgically surged**.

Surgical methods: Methods include diverticular suture or local resection of esophageal diverticulum, combined with achalasia and diaphragm, which should be treated accordingly. The surgical approach is selected according to the location of different types of diverticulum, and the cervical esophageal diverticulum can be resected with a small incision in the neck, and the thoracic esophageal diverticulum can be resected by thoracoscopic surgery** has become a popular surgical method in the world.

Diverticulum is the esophagus in the case of certain diseases or some congenital growth malformations, the esophageal wall is weak, one or more layers bulge outward, and cystic lesions appear, this lesion is called diverticulum, and the esophageal wall is called esophageal diverticulum. Due to a limited bulge of one or all of the esophageal wall, a sac identical to the lumen of the esophagus is formed, called an esophageal diverticulum. Because there is a weak triangle between the hypopharyngeal constrictor muscle and the cricopharyngeal muscle, coupled with the uncoordinated muscle activity, that is, when the hypopharyngeal constrictor muscle contraction will bring food down, the cricopharyngeal muscle does not relax or contract prematurely, causing the esophageal mucosa to bulge from the weak area, so that the local mucosa and submucosal hernia out of the cavity.

Over time, the diverticulum gradually enlarges and sags in the anterior spinal space behind the esophagus.

Esophageal diverticulum refers to a local part of the esophagus that has a cystoid bulge, with true bulge and pseudobulge. The pathogenesis of esophageal diverticulum is not fully understood.

1.According to the location of its occurrence, there are the following types.

pharyngeal esophageal diverticulum, which occurs at the junction between the pharynx and the esophagus; midesophageal diverticulum, which is found in the middle of the esophagus, near the tracheal bifurcation; Supraphrenic diverticulum.

2.According to the diverticulum wall structure, it can be divided into:

True diverticulum, which contains all the tissue structures of the normal esophageal wall, including mucosa, submucosa, and muscle; Pseudodiverticulum, in which the diverticulum contains only mucosa and submucosa.

3.According to the mechanism of occurrence, it can be divided into:

Bulging diverticulum, due to the high pressure in the esophageal lumen, the mucosa and submucosa herniate out of the cavity from the muscle gap, so it is pseudodiverticulum; Traction diverticulum, formed by the scar contraction and traction of the tube wall (full-thickness after the recovery of mediastinal inflammatory lesions adjacent to the esophagus), is a true diverticulum.

1.Pharyngeal esophageal diverticulum.

Early asymptomatic. When the diverticulum is enlarged, there may be a grunting sound when swallowing. If there is food retention in the diverticulum, it can cause a feeling of pressure on the neck.

After the stagnant food is decomposed and spoiled, a foul smell can occur, and it can cause mucosal inflammation and edema, causing difficulty in swallowing. During the physical examination, a soft lump may be palpable on the neck, and there is a gurgling sound when compressed. Giant diverticulum can compress the larynx and cause hoarseness.

If regurgitated food is inhaled into the lungs, it can be complicated by lung infection.

2.Middle esophageal diverticulum.

Often asymptomatic. More often than on esophageal barium swallow x-ray. Esophagoscopy is done to rule out cancer.

3.Supraphrenic diverticulum.

Patients may be asymptomatic or prepared with a variety of symptoms, mainly retrosternal or epigastric pain, sometimes dysphagia and food regurgitation.