Laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus: a case report

• Published in: Surgical case reports Vol. 6; no. 1; p. 151
• Main Authors: Fujinaga, Atsuro, Shibata, Tomotaka, Etoh, Tsuyoshi, Tada, Kazuhiro, Suzuki, Kosuke, Nishiki, Kohei, Ogawa, Katsuhiro, Kono, Yohei, Hiratsuka, Takahiro, Akagi, Tomonori, Ueda, Yoshitake, Toujigamori, Manabu, Shiroshita, Hidefumi, Shiraishi, Norio, Inomata, Masafumi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 29.06.2020; Springer Nature B.V; SpringerOpen
• Subjects: Case Report; Case reports; Epiphrenic esophageal diverticulum; Esophagus; Jackhammer esophagus; Laparoscopy; Medicine; Medicine & Public Health; Motility; Myotomy; Surgery; Epiphrenic esophageal diverticulum; Jackhammer esophagus; Myotomy
• ISSN: 2198-7793; 2198-7793
• DOI: 10.1186/s40792-020-00900-2

Background An esophageal diverticulum is rare and is frequently associated with esophageal motility disorders. Jackhammer esophagus is also rare, is characterized by esophageal hypercontraction, and comprises 4.1% of esophageal motility disorders. Here, we report a case of a patient successfully treated by laparoscopic transhiatal surgery for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus diagnosed with high-resolution manometry (HRM). Case presentation The patient was a 78-year-old man who presented to the hospital with dysphagia. A diverticulum was detected in the lower part of his esophagus by upper gastrointestinal endoscopy. HRM was performed to investigate esophageal motility disorders. His integrated relaxation pressure was normal at 25.9 (< 26) mmHg, but his distal contractile integral (DCI) was very high at 21,464 (1500–13,000) mmHg s cm. Esophageal peristalsis was preserved. Therefore, the patient was diagnosed as having an epiphrenic esophageal diverticulum derived from a jackhammer esophagus for which laparoscopic transhiatal diverticulectomy and Heller-Dor procedure were performed. The postoperative course was uneventful. His symptoms improved, and the level of DCI also returned to a normal level of 3867 mmHg s cm at 2 months after the operation. Conclusion Laparoscopic transhiatal diverticulectomy and esophagomyotomy can be useful procedures for an epiphrenic esophageal diverticulum derived from a jackhammer esophagus due to their lower invasiveness.