Large symptomatic esophageal diverticulum.

A 72 years-old woman derived to Gastroenterology Department from Primary Care due to pyrosis and sometimes dysphagia with 8 years evolution, showing isolated episodes of regurgitation without any other alarms signs, and currently asymptomatic treated with omeprazole. She had a gastroscopy performed diagnosing dilated oesophageal lumen and food rests which were not able to reach gastric cavity being thus suspected of achalasia. She were performed a pHmetry without pathologic reflux sign, oesophageal manometry showing no presence of oesophageal motor alterations, and oesophagogastric transit perceiving a diverticulum in the posterior wall of the oesophageal lower third (Figure 1 and 2) with food content and neither additional alterations nor achalasia signs. Given these findings, patient had gastroscopy performed again, then detecting a large diverticulum (4-5 cm of size) in the distal oesophageal third occupying 50% of the oesophageal lumen and plenty of semi-liquid food rests. After the diverticulum aspiration, whitish mucous mass was observed with erythematous areas around and 1.5 cm sliding hiatal hernia, progressing to second duodenal section without alterations yet. Therefore, due to clinical findings and symptomatology, patient was derived to Surgery Department to assess diverticulectomy.