case_images: PMC7322235_01
case_images: Preoperative imaging findings.. a, b: Upper gastrointestinal endoscopy findings. There was a giant esophageal diverticulum at the lower thoracic esophagus and stenosis in the anal side of the diverticulum (arrow).. c: CT findings. There was a 54 mm esophageal diverticulum at the lower thoracic esophagus and fluid collection within the diverticulum.. d: Upper gastrointestinal contrast study findings. The entrance of the diverticulum was located on the left side of the lower esophagus, and pooling of gastrografin in the diverticulum and delayed passage into the stomach were observed.
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case_images: PMC7322235_01_gr1.jpg
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case_images: Upper gastrointestinal endoscopy revealed a giant esophageal diverticulum at the lower thoracic esophagus and the structural stenosis in the anal side of the diverticulum (Fig. 1a, b). Computed tomography (CT) showed a 54 mm esophageal diverticulum at the lower thoracic esophagus and fluid collection within the diverticulum (Fig. 1c). An upper gastrointestinal contrast study showed that the entrances of the diverticulum were located in the lower esophagus, and pooling of gastrografin in the diverticulum and stenosis in the anal side of the diverticulum were observed (Fig. 1d).
case_images: Operative findings.. a: The cervical esophagus and left recurrent laryngeal nerve were identified and encircled with tape.. b: Port placement. Three 5 mm trocars were inserted through the EZ Access device, and a 12 mm port was added.. c: Peeling off the thoracic esophagus under mediastinoscopy.. d: The diverticulum was identified on the left side of the lower part of the esophagus (arrows).
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case_images: The esophagus was dissected from the surrounding tissue and taped (Fig. 2a). The left recurrent laryngeal nerve was identified and encircled by a piece of rubber tape to avoid inadvertent injury (Fig. 2a). Access device, and a 12 mm port was added to use AIRSEAL  intelligent Flow System (Medical Leaders., Ltd., Tokyo, Japan) (Fig. 2b). A scope was 5 mm ENDOEYE flexible scope (LTF-S190-5, Olympus, Tokyo, Japan) and the pneumomediastinum pressure was maintained at 8 mmHg. We dissected along the thoracic esophagus to the pericardium (Fig. 2c). When spreading the esophageal hiatus and pulling the esophagus to the caudal side, the diverticulum was identified on the left side of the lower part of the esophagus (Fig. 2d).
case_images: Histopathological findings.. a: A 35 x 28 x 25 mm esophageal diverticulum (arrows). Stenosis in the anal side was observed (arrowheads).. b: There was no muscularis propria in the diverticulum (arrowheads).
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