Combined double-endoscopic surgery for a giant left-sided supradiaphragmatic esophageal diverticulum: a case report

Introduction and importance: Esophageal diverticulum is a rare condition, with supradiaphragmatic esophageal diverticula being even rarer, occurring in only approximately 0.06%–4% of cases, and most of these are located on the right side of the esophagus. This article reports a rare case of a giant left-sided supradiaphragmatic esophageal diverticulum, aiming to explore its diagnostic methods, surgical strategies, and therapeutic outcomes, thereby providing a reference for similar complex cases. Case presentation: A 58-year-old male patient was found to have an esophageal diverticulum during a physical examination 3 months ago, which was prompted by long-term symptoms of acid reflux and heartburn. Gastroscopy revealed that the diverticulum was located 38 cm from the incisors, and computed tomography (CT) and barium meal radiography confirmed a left lower thoracic esophageal diverticulum measuring approximately 70 ×55 mm. The patient had long been troubled by acid reflux and heartburn. After undergoing surgery at our hospital, the patient recovered well, with no postoperative complications. Clinical discussion: Thoracic esophageal diverticula are most commonly caused by esophageal motility disorders, with left-sided occurrence being particularly rare. Diagnosis requires a comprehensive assessment combining gastroscopy, CT, and barium meal radiography, and the differential diagnosis should exclude conditions such as hiatal hernia. The combined double-endoscopic technique offers the advantages of minimally invasive surgery and precise operation, effectively reducing injury to the esophageal muscle layer and postoperative complications. Conclusion: This case demonstrates that combined double-endoscopic surgery is a preferred, safe, effective, and minimally invasive option for the treatment of giant or complex esophageal diverticula, and it holds significant value for clinical application.