An uncommon source of upper gastrointestinal bleeding:epiphrenic esophageal diverticulum

Esophageal diverticula are rare findings that have an estimated incidence of 1 per 500000 people per year,even though acute upper gastrointestinal bleeding is a relatively common medical emergency with an incidence of up to 150 per 100000 people per year and a mortality rate of 7-14%.An 83-year-old man presented with hematemesis and melena.Urgent upper endoscopy revealed an esophageal diverticulum,within which was an adherent clot.Removal of the clot identified a bleeding vessel within the diverticulum;this was successfully clipped and hemostasis was achieved.To the best of our knowledge,this is the first case report of a bleeding epiphrenic esophageal diverticulum that was successfully managed endoscopically with hemostatic clips alone.While rare,our case serves as a reminder that bleeding epiphrenic esophageal diverticula can present as massive upper gastrointestinal bleeding and urgent endoscopic therapy can be life-saving.

颈椎内固定术后咽食管憩室1例

1临床资料患者,男,65岁,因“咽部不适1年余,进行性加重2周”入院。患者1年前出现咽部不适,无咽痛、声嘶,近2周出现饮食饮水呛咳,遂至潍坊市人民医院耳鼻咽喉科行钡餐检查示(图1A):食管上端前部有一较大的囊袋样憩室充盈,压迫局部食管变窄,钡剂通过受阻、部分造影剂逆行向前上方反流进入喉及气管和支气管内。后为求进一步治疗就诊于我院胸外科门诊,以“食管憩室”收治入院。患者既往白癜风病史20年余,自发病以来偶有呛咳和食管反流症状,曾于2015年7月因外伤于当地医院行颈部钢板固定术,钢板未取出。其余无特殊。经胸外科联系我科、脊柱外科、消化内科进行多学科会诊,讨论结果为:患者钡餐考虑食管憩室,诊断明确。消化内科建议因食管憩室较高,行食管支架手术后支架存在脱落可能性较大,暂不考虑行支架治疗。我科会诊建议:患者目前咽喉反流严重,考虑为憩室压迫所致,可转我科行手术治疗,术中请脊柱外科医师同台手术取出脊柱钢板。后患者及家属同意转至我科进一步手术治疗,术前再次行颈部增强CT及MRI检查明确颈部情况(图1B,图1C)。排除手术禁忌后,联合脊柱外科、麻醉科于2021-01-19全麻下行“食管憩室切除术+颈椎内固定取出术”。