Double trouble of corrosion – Rare case of bilobed esophageal diverticulum

Acute corrosive ingestions can cause coagulative or liquefactive necrosis followed by a triphasic healing process that can culminate in fibrosis, strictures, and, rarely, diverticular formation. We report a rare case of a large bilobed esophageal diverticulum secondary to chronic corrosive stricture in a patient presenting with a 4-year history of progressive dysphagia, vomiting, and transient left neck swelling during deglutition. The barium swallow showed a supra-aortic benign esophageal stricture with a large proximal bilobed diverticulum extending from the upper esophageal sphincter to D2, findings confirmed on axial computed tomography. The endoscopy revealed the diverticulum, causing near-complete compression of the supra-aortic esophagus, thus giving a stricture-like appearance on the imaging. The post-peroral endoscopic myotomy was performed, and the post-procedure esophagogram showed significant improvement in the luminal caliber and restored passage of contrast with significant clinical relief. This case underlines the importance of a multimodality imaging approach in differentiating benign corrosive strictures from malignant mimics, identifying a structural complication such as diverticula, and guiding appropriate therapeutic planning.