Gullet diverticulums – the deformation of an ezofagealny wall which is characterized by the meshotchaty vybukhaniye of its layers turned towards a sredosteniye. The diverticulum of a gullet can be shown by feeling of irritation, a gipersalivation, feeling of a lump in a drink, a dysphagy, a regurgitation, a putrefactive smell from a mouth. Diverticulums are diagnosed by means of a X-ray analysis of a gullet, an ezofagoskopiya, a manometriya. Radical treatment assumes excision of a diverticulum of a gullet (divertikulektomiya) or an invagination (vvorachivaniye) of a diverticulum in a gullet gleam.
Gullet diverticulums (ezofagealny diverticulums) come to light at 2% of persons at radiological inspection. In gastroenterology among digestive tract diverticulums they make about 40%. More often diverticulums of a gullet are diagnosed for men 50 years, as a rule, having other diseases of a gastrointestinal tract – stomach ulcer, cholecystitis, cholelithiasis and so forth are more senior.
The diverticulum can develop in any segment of a gullet, however is more often formed in its chest department. In 90% of cases the diverticulum is single, in 10% multiple protrusions of a wall of a gullet are observed.
Classification of diverticulums of a gullet
In the location distinguish pharyngeal and esophageal (faringoezofagealny, Tsenker's diverticulum), epibronkhialny (srednepishchevodny, bifurcation), naddiafragmalny (epifrenalny), poddiafragmalny (abdominal) diverticulums of a gullet.
By origin and emergence time diverticulums of a gullet are classified on congenital and acquired. As a structure distinguish the true diverticulums consisting of all layers of an esophageal wall and the pseudo-diverticulums (false) which do not have a muscular cover. False diverticulums are formed protrusion of a mucous membrane of a gullet through defect in a muscular layer; they arise at the time of peristaltic reduction of an esophageal wall and disappear at its relaxation.
On the education mechanism diverticulums of a gullet can be pulsionny, traction or mixed - pulsionno-traction.
Reasons of formation of diverticulums of a gullet
The origin of diverticulums of a gullet can be various. Formation of a congenital diverticulum of a gullet is, as a rule, connected with primary weakness of a muscular layer of an esophageal wall on a certain site.
In development of the acquired gullet diverticulums an essential role is played by inflammatory processes of the top departments of a GIT and a sredosteniye. Often formation of a diverticulum of a gullet is preceded by a long current of an ezofagit and a gastroezofagealny reflux disease, mediastinit, tuberculosis of intra chest lymph nodes, a fungal infection of a gullet (ezofagealny ). Also the gullet injury, , an akhalaziya of a sebesten, a gullet striktura can lead to development of an ezofagealny diverticulum.
Formation of a pulsionny diverticulum of a gullet is caused by violation of the ezofagealny motility leading to spastic reductions of muscles, increase in intra esophageal pressure and a vybukhaniye of a wall in the weakest point (it is frequent above functional or organic narrowing).
Development of a traction diverticulum of a gullet is promoted by soyedinitelnotkanny unions of walls of a gullet with the inflamed sredosteniye lymph nodes which cause stretching and shift of an ezofagealny wall towards a sredosteniye with formation of pathological protrusion. Sometimes pulsionny and traction mechanisms influence at the same time.
Gullet diverticulum symptoms
Clinical manifestations of diverticulums of a gullet depend on their localization. Tsenker's diverticulums located in the field of pharyngeal and esophageal transition give the brightest symptomatology. At tsenkerovsky diverticulums of a gullet the dysphagy – the complicated passing of both firm, and liquid food on a gullet early develops. The remains of food accumulate in a diverticulum that is followed by vomiting undigested food, an unpleasant smell from a mouth.
Regurgitation can be observed in a prone position in this connection patients often find when awakening slime and the remains of food on a pillow. Also patients can complain of irritation, a throat scratching, feeling of not swallowed lump in a throat, dry cough. Nausea, a gipersalivation, change of a timbre of a voice is often noted. Development of "a blockade phenomenon" when after meal there is face reddening, feeling of suffocation, dizziness is characteristic, the faint develops. This state is usually stopped after vomiting.
Small (to 2 cm) bifurcation and naddiafragmalny diverticulums of a gullet usually bessimptomna. Diverticulums of the big sizes are followed by a dysphagy, vomiting of undigested food, an aerofagiya (swallowing air), zagrudinny pains, nausea, night cough. Clinical manifestations of a bifurcation diverticulum of a gullet can be provoked by Valsava's test. At diverticulums of the lower department of a gullet reflex short wind, tachycardia, a bronchospasm, pains in heart, changes of the ECG joins clinic of disorder of digestion.
Diverticulums of a gullet can be followed divertikulity and its complications – neck phlegmon, mediastinity, by education esophageal fistula, sepsis. Regurgitation with aspiration of food masses is led to development of chronic bronchitis, aspiration pneumonia, lung abscess. Potential danger at diverticulums of a gullet is constituted by an erozirovaniye mucous, ezofagealny bleeding, formation of polyps of a gullet, development of cancer of gullet.
Diagnostics of diverticulums of a gullet
Tsenker's diverticulum of the big sizes can be found at survey and a palpation of a neck. It represents protrusion in a neck of a soft consistence which decreases when pressing. By means of a X-ray analysis of a gullet existence and localization of a diverticulum of a gullet is established, width of his neck, barium delay time, existence of pathological processes (polyps, cancer, fistula) is defined. Carrying out a survey X-ray analysis and KT of bodies of a thorax can give important information: diverticulums of a gullet of the big sizes are visible in pictures as filled with liquid and air of a cavity, reported with a gullet.
Ezofagoskopiya allows to examine a diverticulum cavity, to find ulcerations of mucous, to establish the bleeding fact, to reveal tumors, to execute an endoscopic biopsy. Due to the high risk of perforation of a diverticulum of a gullet the ezofagoskopiya is carried out carefully. For the purpose of studying of sokratitelny function of a gullet carry out an ezofagealny manometriya - a research of esophageal motility. To patients hold consultation of the cardiologist, research ECG, holterovsky monitoring, EhoKG with coronary symptoms.
Differential diagnostics of a diverticulum of a gullet is carried out with GERB, ezofagospazmy, hernia of an esophageal opening of a diaphragm, strikturama of a gullet, an akhalaziy sebesten, gullet cancer, a sredosteniye cyst, stenocardia, IBS.
Treatment of a diverticulum of a gullet
Small diverticulums of a gullet with a malosimptomny current are treated conservatively under observation of the gastroenterologist. Observance of the diet based on the principles of a thermal, chemical and mechanical shchazheniye of a gullet is recommended to patients. After food holding the simple actions directed to the best depletion of a diverticulum of a gullet is expedient: the water use, a natuzhivaniye, acceptance of the draining pose, washing of a cavity weak solution antiseptics.
Surgical treatment of diverticulums of a gullet is carried out at the big defects which are followed by the expressed dysphagy, pains or the complicated current (perforation, a penetration, a gullet stenosis, bleeding etc.). In these cases excision of a diverticulum of a gullet – a divertikulektomiya with plasticity of a gullet a diafragmalny or pleural rag is usually made. Small diverticulums of a gullet can be eliminated by an invagination – immersion of a diverticulum in a gleam of a gullet and an ushivaniye of an esophageal wall.
Forecast and prevention of diverticulums of a gullet
Expeditious treatment of a diverticulum of a gullet gives total disappearance of symptomatology and the good remote results. At the complicated course of a disease the forecast always serious. Therefore even asymptomatic diverticulums of a gullet demand carrying out control researches and treatment of the accompanying pathology.
Prevention of formation of diverticulums of a gullet is promoted by timely therapy of the diseases leading to their education and also slow meal with its careful chewing.