de Oliveira Luciana Lopes, Carneiro Fred Olavo Aragão Andrade, Baba Elisa Ryoka, Vilaça Thiago Guimarães, Chaves Dalton Marques, Artifon Everson Luiz de Almeida, de Moura Eduardo Guimarães Hourneaux, Sakai Paulo
Gastrointestinal Endoscopy Unit, São Paulo University Medical School, 05403-900 São Paulo, SP, Brazil.
Case Rep Med. 2013;2013:154767. doi: 10.1155/2013/154767. Epub 2013 Nov 19.
A 76-year-old woman, presenting with a 4-year history of progressive dysphagia, was submitted to endoscopic examination. The upper endoscopy revealed a proximal esophageal stricture and inflammatory mucosa associated with multiples small orifices in the esophageal wall, some of them fulfilled with white spots suggestive of fungal infection. This was a typical endoscopic finding of esophageal intramural pseudodiverticulosis, a benign and rare condition, related to chronic esophagitis and others comorbid states, such as gastroesophageal reflux disease or infectious esophagitis, diabetes mellitus, alcohol consumption, and achalasia. Dysphagia is the predominant symptom and can be accompanied by esophageal stricture in 80% to 90% of patients. The pathogenesis is unknown, and as the pseudodiverticulosis is an intramural finding, endoscopy biopsies are inconclusive. The main histological finding is dilation of the submucosal glands excretory ducts, probably obstructed by inflammatory cells. The treatment consists in management of the underlying diseases and symptoms relief. In this particular case, the patient was submitted to antifungal drugs followed by endoscopic dilation with thermoplastic bougies, with satisfactory improvement of dysphagia.
