True Oesophageal Diverticulum—pulsion or Traction

Background Oesophageal diverticulum is a rare oesophageal condition. This finding can be classified based on location, aetiology, and whether it is a true or false diverticulum. Mid- oesophageal diverticulum is rare, and is usually a true traction diverticulum. It is usually small and asymptomatic. We present a case of a true pulsion mid esophageal diverticulum who presented with dysphagia. Methods This is a case report of an unusual mid- oesophageal pulsion true diverticulum. Pre- operative endoscopy, CT thorax, high resolution manometry are performed to characterize the lesion and to rule out differentials. Results Endoscopy revealed a wide neck diverticulum at 7 cm from the gastro esophageal junction. HRM showed diffuser esophageal spasm. A CT thorax did not show any mediastinal abnormalities. The lesion was thought too be an epiphrenic diverticulum. A laparoscopic transhiatal approach was selected. Diverticulectomy, cardiomyotomy and an anterior fundoplication was performed. Conclusion Histopathology demonstrated a true oesophageal diverticulum. A routine post-operative contrast swallow demonstrated no leak or hold-up of the contrast. The patient recovered well and was discharged on post-operative day 2. This was likely a pulsion type mid-oesophageal diverticulum. It is unclear why this presented as a true diverticulum. Treatment was undertaken to relieve the patient’s symptoms and likeliest underlying cause.