An 86-year-old woman with a history of total thyroidectomy for endothoracic multinodular goiter, dermatitis denudativa in 2011 secondary to amoxicillin, esophageal diverticulum and small hiatal hernia.
The patient presented dysphagia predominantly to liquids, which led to hospital admissions for aspiration three times.
At the last admission, a known diverticulum located about 28 cm of dental arch was confirmed by endoscopy.
The six patients described underwent high resolution manpower (HRM), identifying in all cases a concomitant esophageal motor disorder (EMD).
The findings obtained with MAR in each patient are shown in Table I. The reference values used were the parameters described in the current Chicago classification (7).
The patient in the first case presented hypercontractile waves in segments S2 and S3, compatible with the manometric diagnosis of hypercontractile MSD ("jackhammer").
The second patient's MAR revealed a distal esophageal spasm-type MSD, affecting the S3 segment.
In the third case, the ARM revealed a weak peristalsis-type MSD due to a small peristaltic defect in the isobaric contour of 20 mmHg (50% of the double and 56% of the triple S segment), respectively on
The patient in case 4 had an obstruction to the outflow tract of the gastroesophageal junction (GEJ) and simultaneously a SME with traces of type III achalasia (peristaltic orifice area) of probable secondary origin.
Patient 5 also had a hypercontractile type EMR ("jackhammer") with large waves in segments S2 and especially in S3.
In the patient of case 6 we observed a SMR consisting of obstruction to the outflow of the GEJ, as well as alteration in the contractile sequence in the area of the esophageal diverticulum consisting of S2-interval3 segments.
In all cases, the segment predominantly affected by the ARM was located in the endoscopic studies.
Five patients required surgical treatment.
The patient of the first case was treated by esophagectomy complicated with pleural-esophageal fistula and treated by placement of a covered metallic esophageal prosthesis (Wallflex®).
Patients in the second and third cases continued conservative management after estimating the surgical option due to the risk of morbidity and mortality associated with it.
The patient in the fourth case presented an episode of upper gastrointestinal bleeding, and an urgent endoscopic study identified a large clot adhered to the diverticulum wall.
This accelerated the decision to surgically treat ED after overcoming the digestive bleeding episode.
However, in the days following the hemorrhagic event, the patient developed septic picture secondary to pneumonia of origin, eventually dying.
The patient of the fifth case was treated surgically, performing a resection and myotomy through endoscopy.
The evolution was torpid to present mediastinitis secondary to esophageal-pleural fistula.
It was treated by placing a covered metallic esophageal prosthesis (Wallflex®).
Patient number six was treated by injection of botulinum toxin at the level of the GEJ to solve the functional obstruction.
The best treatment was considered due to the age of the patient, improving the symptoms.
