Bronchopulmonary malformation of the foregut communicating with the distal Oesophagus in a form of an Epiphrenic diverticulum. An exceptional cause of epiphrenic diverticulum in adults: Case report

Introduction: Epiphrenic diverticula are rare entities, generally asymptomatic. Most symptomatic ones occur in the form of dysphagia and are related to primary hypertensive oesophageal motor disorders of the distal oesophagus or the lower oesophageal sphincter. Exceptionally, they have been associated with congenital abnormalities in the formation of the primitive foregut. Case presentation: An 85-year-old male patient with symptoms of dysphagia was diagnosed with epiphrenic diverticulum. Functional studies revealed associated oesophageal motility disorders. A transhiatal laparoscopic approach was used to perform a diverticulectomy, myotomy, and partial anterior fundoplication. The histological study of the diverticulectomy specimen was compatible with extralobar pulmonary sequestration communicating with the distal oesophagus. Discussion: Bronchopulmonary malformations are very rare entities. A complete preoperative study of an epiphrenic diverticulum facilitates a correct differential diagnosis and decision-making. Endoscopy with biopsies can help define its etiology, rule out malignancy, and even change the therapeutic approach. The surgical approach depends on the morphological characteristics of the diverticulum, the surgical technique to be performed, and the surgical team experience. Intraoperative endoscopic resources facilitate surgical manoeuvres and guarantee the safety of the procedure. Conclusion: Bronchopulmonary malformation of the foregut communicating with the distal oesophagus in the form of an epiphrenic diverticulum is an extremely rare condition. However, it should be included in the differential diagnosis of an epiphrenic diverticulum. Transhiatal laparoscopic resection under intraoperative endoscopic control is safe and effective for treating this entity.