Large Epiphrenic Diverticulum with Perforation and Leakage below the Diaphragm: A Case Report

We present a rare case of an epiphrenic esophageal diverticulum, complicated by
perforation and leakage below the diaphragm in a 57-year-old male patient. The patient was referred to the emergency department with suspected aspiration pneumonia. A thoracoabdominal computed tomography with oral contrast revealed contrast leakage near the minor curvature of the stomach. The following esophagogastroduodenoscopy demonstrated a giant dilatation of the esophagus, as well as a second esophageal lumen originating 25 cm from the incisors. The “false” lumen of the esophagus was located parallel to esophagus, ending blindly in a perforation below the diaphragm. The clinical presentation and the patient’s age make it most likely, that it was a long epiphrenic diverticulum of pulsion type. The patient was treated conservatively, discharged after 10 days and has been followed in our outpatient clinic for 8 months, until he died of aggressive pulmonary cancer.