Middle esophageal diverticulum
ICD-10 K22.5 · ICD-11 DA20.1&XA2BY3

Treatment of Mid-Thoracic Traction Esophageal Diverticulum Secondary to Mediastinal Inflammation, Without Motility Disorder

This protocol covers the specific clinical scenario of a middle (mid-thoracic) traction esophageal diverticulum arising secondary to a mediastinal inflammatory process, where radiological and manometric evaluation shows no esophageal motility disorder or manometric abnormality.

Clinical Scenario

Mid-esophageal diverticula at this level are characteristically true traction diverticula, forming secondary to mediastinal inflammatory processes. In this scenario, the etiopathogenesis is clear: no evidence of a pulsion or motility-driven mechanism on radiological or manometric assessment. This specific presentation determines the treatment pathway.

Treatment Approach

Surgical intervention is the compulsorily indicated approach in this setting, performed via a thoracic route — the full operative technique, anatomical considerations, and choice among surgical options are detailed in the complete protocol.

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References

  1. Midesophageal EDs are usually true, traction diverticula, secondary to mediastinal inflammatory processes (classically, traction diverticula are described at this level, but pulsion diverticula can also be found).
  2. Traction diverticula with clear etiopathogenesis (without radiological or especially manometric abnormalities) that suggest or demonstrate the participation of a drive mechanism are rarely indicated for surgery.
  3. The indication for surgery is compulsory.
  4. The operation is usually performed by thoracotomy, although thoracoscopic solutions are also cited.
  5. The operation consists in dissecting the fistulous tract and obturating it, preferably by mechanical suture transection; in order to prevent a recurrence, the anatomical structures in the proximity of the esophagus and the bronchial wall are interposed, unaffected by inflammation (pleural or fascial flap, transposition of pediculated intercostal muscles).
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