Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm

• We performed diverticulectomy without myotomy for normal esophageal motility in HRM.
• HRM revealed diffuse esophageal spasm of the patient, who complained of dysphagia.
• The motility disorder was likely not identified at the first evaluation.
• The symptoms resolved without treatment; however, longer-term follow-up is needed.

IntroductionEsophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter.Presentation of caseWe herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10 cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm.DiscussionThe diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation.ConclusionIn this case, the patient’s symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed.