Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2015; 21(30): 9223-9227
Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9223
Esophageal intramural pseudodiverticulosis of the residual esophagus after esophagectomy for esophageal cancer
Nobuyoshi Takeshita, Naoki Kanda, Toru Fukunaga, Masayuki Kimura, Yuji Sugamoto, Kentaro Tasaki, Masaya Uesato, Tetsutaro Sazuka, Tetsuro Maruyama, Naohiro Aida, Tomohide Tamachi, Takashi Hosokawa, Yo Asai, Hisahiro Matsubara
Nobuyoshi Takeshita, Naoki Kanda, Toru Fukunaga, Masayuki Kimura, Yuji Sugamoto, Kentaro Tasaki, Tetsutaro Sazuka, Tetsuro Maruyama, Naohiro Aida, Tomohide Tamachi, Takashi Hosokawa, Yo Asai, Department of Surgery, Numazu City Hospital, Shizuoka 410-0302, Japan
Masaya Uesato, Hisahiro Matsubara, Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
Author contributions: Takeshita N, Kanda N, Fukunaga T, Uesato M and Matsubara H planned the report; Takeshita N, Kanda N, Fukunaga T, Kimura M, Sugamoto Y, Tasaki K, Sazuka T, Maruyama T, Aida N, Tamachi T, Hosokawa T and Asai Y performed the treatment for this case; and Takeshita N wrote the paper.
Institutional review board statement: The case report was reviewed and approved by Numazu City Hospital Institutional Review Board.
Informed consent statement: The patient provided informed written consent prior to treatment and publication.
Conflict-of-interest statement: We have no financial relationships to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nobuyoshi Takeshita, MD, PhD, Department of Surgery, Numazu City Hospital, Shizuoka 410-0302, Japan. ntakeshita1225@gmail.com
Telephone: +81-55-9245100 Fax: +81-55-9245133
Received: February 9, 2015
Peer-review started: February 10, 2015
First decision: March 10, 2015
Revised: April 7, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 14, 2015
Processing time: 188 Days and 22.1 Hours
Abstract

A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer (T3N2M0 Stage III) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation, including redness, erosion, edema, bleeding, friability, and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine, gastrografin-filled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly, endoscopic balloon dilatation was performed and anti-fungal therapy was started in the hospital. Seven weeks later, endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently, the patient was discharged. At the latest follow-up, the patient was symptom-free and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.

Keywords: Esophageal intramural pseudodiverticulosis; Esophageal cancer; Esophageal candidiasis; Anastomotic stricture; Esophagectomy; Residual esophagus

Core tip: Although esophageal intramural pseudodiverticulosis (EIPD) itself is a very rare disease, we encountered a case of EIPD occurring in the residual esophagus after esophagectomy. To our knowledge, no previous reports have described EIPD as a cause of benign stricture in esophagogastric anastomosis. The mucosal inflammation and stricture were treated with endoscopic balloon dilatation and anti-fungal therapy. Herein, we report the first case of EIPD showing anastomosis stricture 11 years after esophagectomy was performed to treat esophageal cancer.