Sayles Mark, Harrison Laura, McGlashan Julian A, Grant David G
Department of Otolaryngology-Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
BMJ Case Rep. 2013 Dec 12;2013:bcr2013200702. doi: 10.1136/bcr-2013-200702.
A 72-year-old woman presented with long-standing gastro-oesophageal reflux, regurgitation of swallowed food and worsening cervical dysphagia. Fluoroscopic barium oesophagography revealed a posterolateral pharyngeal pouch (Zenker's diverticulum (ZD)) complicating a 'cup and spill' oesophageal deformity with a smoothly tapered segment at the gastro-oesophageal junction. CT and high-resolution manometry confirmed that the underlying abnormality was a massively dilated oesophagus with aperistalsis and pan-oesophageal pressurisation, consistent with a diagnosis of oesophageal achalasia (type II). She underwent endoscopic stapled diverticulotomy, with good symptomatic relief. We discuss the aetiology of ZD, its management and the association here with oesophageal achalasia.
一名72岁女性,长期存在胃食管反流、吞咽食物反流及颈部吞咽困难加重症状。透视下食管钡餐造影显示一个咽后壁憩室(Zenker憩室(ZD)),合并“杯口状及溢出”型食管畸形,在胃食管交界处有一段平滑变细的节段。CT和高分辨率测压证实潜在异常为食管重度扩张伴无蠕动及全食管压力升高,符合食管失弛缓症(II型)诊断。她接受了内镜下吻合器憩室切除术,症状得到明显缓解。我们讨论了ZD的病因、治疗及其与食管失弛缓症的关联。