Kurahashi Yasunori, Hojo Yudai, Nakamura Tatsuro, Kumamoto Tsutomu, Nakanishi Yasutaka, Ishida Yoshinori, Shinohara Hisashi
Department of Surgery, Upper Gastrointestinal Division, Hyogo College of Medicine, 1-1 Mukogawa-Cho, Nishinomiya City, Hyogo, 663-8501, Japan.
Surg Case Rep. 2020 Aug 3;6(1):192. doi: 10.1186/s40792-020-00949-z.
Killian-Jamieson diverticulum is a rare pharyngoesophageal diverticulum that arises below the cricopharyngeus muscle. Unlike the most common Zenker's diverticulum, which requires cricopharyngeal and esophageal myotomy, diverticulectomy is sufficient for surgical treatment of Killian-Jamieson diverticulum. Thus, accurate preoperative diagnosis is indispensable for avoiding unnecessarily invasive surgery. Here, we report a case of Killian-Jamieson diverticulum in which endoscopic observation of the palisade vessels was useful for diagnosis and intraoperative endoscopy was effective in guiding surgical resection.
A 65-year-old woman complained of pharyngeal discomfort and increased coughing and was referred to our hospital with a diagnosis of a pharyngoesophageal diverticulum. Contrast esophagography and cervical computed tomography revealed a diverticulum measuring 3 cm in diameter on the left side of the cervix. The diverticulum was identified by endoscopy just below the palisade vessels, which represents the level of the upper esophageal sphincter, and was diagnosed as Killian-Jamieson diverticulum. She underwent diverticulectomy without cricopharyngeal and esophageal myotomy. After exposing the diverticulum under light from the endoscope and washing out the food residue inside endoscopically, the diverticulum was resected using the endoscope as a bougie so as not to narrow the esophagus. The postoperative course was uneventful, and she remains asymptomatic without recurrence or stenosis at 6 months after surgery.
Endoscopic observation of the palisade vessels in addition to esophagography can help diagnose Killian-Jamieson diverticulum and determine the optimal surgical procedure. Diverticulectomy can be performed intentionally and safely with the aid of intraoperative endoscopy.
基利安-贾米森憩室是一种罕见的咽食管憩室，起源于环咽肌下方。与最常见的需要进行环咽肌和食管肌层切开术的Zenker憩室不同，憩室切除术足以治疗基利安-贾米森憩室。因此，准确的术前诊断对于避免不必要的侵入性手术必不可少。在此，我们报告一例基利安-贾米森憩室病例，其中对栅栏状血管的内镜观察有助于诊断，术中内镜检查对指导手术切除有效。
一名65岁女性主诉咽部不适和咳嗽加重，被转诊至我院，诊断为咽食管憩室。食管造影和颈部计算机断层扫描显示，宫颈左侧有一个直径3厘米的憩室。在内镜检查中，在代表食管上括约肌水平的栅栏状血管下方发现了憩室，并诊断为基利安-贾米森憩室。她接受了憩室切除术，未进行环咽肌和食管肌层切开术。在内镜灯光下暴露憩室并在内镜下冲洗掉内部的食物残渣后，以内镜为探条切除憩室，以免食管狭窄。术后过程顺利，术后6个月她仍无症状，无复发或狭窄。
除食管造影外，对栅栏状血管进行内镜观察有助于诊断基利安-贾米森憩室并确定最佳手术方法。借助术中内镜检查，可以有意且安全地进行憩室切除术。
