Esophageal pseudodiverticulosis

Oesophageal intramural pseudodiverticulosis is an uncommon condition comprising ofin which there are numerous small outpouchings within the oesophageal wall.

Epidemiology

OccursIt is a rare condition, found in all<1% of oesophagrams. It may occur at any age groups, but is more commonly in the 6^th and 7^th decadescommon at 50-70 years old. There is a slight male predominance ².

Associations

• oesophageal strictures: present in 90% of patients ¹
• oesophageal candidiasis
• oesophagitis
• oesophageal carcinoma ²

Pathology

Intramural pseudodiverticula represent dilated excretory ducts of the deep oesophageal mucosal glands ¹.

Radiographic features

Fluoroscopy: barium swallow

Barium swallow examination is the study of choice, as the ductal orifices aremay be too small to be seen on endoscopy. Pseudodiverticula are bestbetter seen with a single contrast, rather than examination than with a double contrast, thin barium examination ^1,2. 

• numerous, tiny (1-4 mm), flask-shaped outpouchings
• may be diffusely distributed or clustered.
• clustering may occur next to peptic strictures
• viewed in profile, often appear “floating” next to the oesophageal wall, as the channel to the lumen is impercebtibleimperceptible
• viewed onen face, may look like ulcers ³
• intramural tracking may sometimes be seen bridging two or more pseudodiverticula ⁴² 

Treatment and prognosis

Pseudodiverticular rupture with mediastinitis has been reported but is very rare ⁴.