Thoracotomy for Esophageal Pseudodiverticulum Following Cardiac Surgery

Esophageal pseudodiverticulum (EPD), a rare benign condition, is typified by the presence of outpouching flask-shaped lesions across the esophagus. EPD, often secondary to a motility dysfunction, is associated with various condition, however, has not be reported following mitral valve replacement (MVR). We report a case of a 45-year-old male with progressive dysphagia to solids and liquids over 1 month, along with regurgitation and vomiting. Twelve months ago, he had undergone thoracotomy for MVR. Physical examination revealed signs of malnutrition and epigastric tenderness. Upper gastrointestinal endoscopy revealed a fistulous opening, 33 cm from the incisors, in the lower esophagus. Moreover, endoscopic ultrasound suspected an esophageal fistula. Esophageal pH monitoring and esophageal manometry were normal. The patient underwent a right thoracotomy for diverticulum excision and primary esophageal repair. Postoperatively, the patient remained asymptomatic, with no recurrence of dysphagia at 18 months follow-up. Thus, our case highlights the importance of imaging in the diagnosis of EPD and demonstrates the effectiveness of thoracotomy in the resolution of symptoms with a favorable outcome.