S4344 Swiss Cheese in Esophagus? A Case of Esophageal Intramural Pseudodiverticulosis Presenting With Food Bolus and Dysphagia

Introduction: Esophageal Intramural Pseudodiverticulosis (EIP) is a rare disease characterized by multiple flask-shaped outpouching lesions of the esophageal wall with unclear exact etiology. Cases present with dysphagia and food impaction in association with a proximal esophageal stricture, although many cases are asymptomatic and can be found incidentally. Case Description/Methods: Fifty-four-year-old man with multiple comorbidities including diabetes, gastroparesis, alcoholic cirrhosis of the liver, and laryngeal cancer who was transferred to our facility after presenting with fatigue and fever in the setting of leukocytosis attributed to aspiration pneumonitis. Exam was notable for stigmata of chronic liver disease. The patient also had history of food bolus 2 months prior, which required endoscopic removal. Repeat esophagogastroduodenoscopy showed esophageal pseudo-diverticulosis extending from 25 cm to 38 cm with multiple pseudo lumens. Pathology samples showed submucosal chronic inflammation and mild reflux changes consistent with EIP diagnosis. The patient was discharged home with antireflux precautions and acid suppression therapy. Patient was recommended for outpatient follow-up with plans to attempt empiric dilation if no improvement in symptoms. However, the patient deceased from his other comorbidities. Discussion: EIP as a cause of dysphagia is a rare presentation of a very common condition. Although our patient had dysphagia with history of food bolus, previous EGDs did not comment on EIP. Treatment of EIP is directed toward the accompanying medical conditions and symptom relief, like antireflux medications for patients with coexisting esophagitis. Moreover, mechanical dilatation of the accompanying esophageal strictures has been shown to result in considerable clinical response, which was our next planned step in management.