Esophageal diverticula are uncommon lesions that are usually classified according to their location (cervical, thoracic, or epiphrenic), or underlying pathogenesis (pulsion or
traction), and their morphology (true or false).The majority of
esophageal diverticula are acquired lesions that occur predominantly in elderly adults. Pulsion, or false,
diverticula are the most commonly encountered type of
esophageal diverticula noticed at the level of cricopharyngeus muscle, occur as a localized outpouchings that lacks a muscular coat, and as such their wall is formed entirely by mucosa and submucosa. True, or
traction,
esophageal diverticulum (TED) is seen in the middle one third of the thoracic esophagus in a peribronchial location, occurs secondary to mediastinal inflammatory lesions such as
tuberculosis or
histoplasmosis. The resultant desmoplastic reaction in the paraesophageal tissue causes full thickness pinching on the esophageal wall, producing a conical, broad-mouthed true
diverticulum. They often project to the right side because subcarinal lymph nodes in this area are closely associated with the right anterior wall of the esophagus. TED usually presents with symptoms such as
dysphagia, postural regurgitation,
belching, retrosternal
pain,
heartburn, and epigastric
pain. As in patients with pharyngoesophageal (
Zenker's) diverticula, pulmonary symptoms are often present but underestimated in TED patients. These symptoms range from mild nocturnal
cough to life-threatening massive aspiration. In this particular report we describe a rare case of TED presenting as a symptomatic upper gastrointestinal
bleeding. Diagnostic evaluation of TED includes chest X-ray,
barium esophagogram and manometry. A significant proportion of lower
esophageal diverticula are associated with motility disorders. Management of TED include treating the underlying cause sometimes a surgical resection of
diverticulum along with esophageal
myotomy is necessitated in symptomatic patients.