What is esophageal diverticulum The main cause of esophageal diverticulum is localized weakness or lack of esophageal wall muscle layer, which makes the esophageal mucosa and submucosa protrude outward. Mostly seen in middle-aged and elderly people, men are about 2 times more than women. The course of the disease is long, and the severity of symptoms is related to the type and development of diverticula. At the beginning, there are no symptoms, or there is a feeling of foreign body in the throat and a transient feeling of food stagnation and increased salivation. As the diverticulum expands and does not empty easily, it can show slow progressive dysphagia, hiccups and regurgitation, regurgitation of undigested food and mucus, and has a certain relationship with the change of body position. Some patients have fullness or masses at the root of the neck during feeding, mostly on the left side, and can empty the diverticulum by manual massage. Gargling sounds can be heard during drinking. There is mostly bad breath. Huge diverticula can have obvious compression symptoms such as hoarseness, dyspnea, severe swallowing difficulties and even inability to eat. Malnutrition, swelling, or cachexia may occur. Supradiaphragmatic diverticula often have position-related intermittent vomiting and chest and back pain, sometimes similar to angina pectoris. Most mid-oesophageal traction diverticula are asymptomatic and are found incidentally on x-ray. Reflux also often occurs at night, with choking and coughing due to inadvertent aspiration of the reflux, and the patient is awakened from sleep with a feeling of stuffiness and choking. Respiratory symptoms are common, and even lung abscesses may occur. The danger of esophageal diverticulum Due to the accumulation of food, diverticulum will continue to increase and gradually fall, which is not conducive to the discharge of the accumulated materials within the diverticulum, resulting in the opening of the diverticulum is facing the lower side of the pharynx, the food swallowed first into the diverticulum and reflux occurs, at this time there are swallowing difficulties, and progressive aggravation, some patients also have bad breath, nausea, loss of appetite and other symptoms. Some of them have malnutrition and weight loss due to difficulty in eating. In the absence of treatment, if the diverticulum gradually increases in size, the accumulated food and secretions begin to increase, sometimes automatically returning into the mouth, occasionally causing aspiration. The result of aspiration will lead to comorbidities such as pneumonia, atelectasis, or lung abscess. Hemorrhage and perforation are less common comorbidities. Very few pharyngoesophageal diverticula become cancerous, probably due to long-term food and secretion irritation. If irregularities in the wall of the diverticulum are found during barium imaging, diverticular carcinoma should be highly suspected and further examination is needed. Main tests: Esophagoscopy: It is generally not routine, but it is necessary when complications are suspected. The diverticular mucosa should be the same color as normal esophageal mucosa in the absence of complications. If there is congestion, edema, erosion, neoplasia, brushings and biopsy should be made to obtain cytological and histological diagnosis. Barium swallow X-ray examination of esophagus: liquid plane is occasionally seen on plain film, and the diverticulum at the back of the esophagus can be seen by taking barium, and if the diverticulum is huge and obviously compressing the esophagus, a barium shadow can be seen after the barium enters the diverticulum, and then a barium shadow flows from the opening of the diverticulum to the esophagus below. Repeated changes in body position during imaging are beneficial to the filling and emptying of diverticula, facilitating the discovery of small diverticula and observing whether the mucosa inside the diverticula is smooth, except for early malignant changes. Chest CT: clarify the opening, location, size and relationship with the aorta and trachea of the esophageal diverticulum. Treatment Asymptomatic, small esophageal diverticula do not require treatment and can be observed. If the symptoms worsen, the diverticulum grows larger or complications such as inflammation, foreign body perforation or bleeding occur, esophageal diverticulectomy is required. The surgical methods are divided into traditional open surgery and minimally invasive thoracoscopic surgery. At present, most of the cases in our department can be completed by minimally invasive surgery, which is less traumatic and the patient recovers quickly. Preoperative preparation: eat liquid food within 48h before surgery, change the position as much as possible to empty the residue inside the diverticulum, if the nasogastric tube can be sent into the diverticulum under fluoroscopy before surgery, and repeatedly rinse and aspirate the residue, it is helpful to prevent misaspiration during induction of anesthesia. Esophageal diverticulectomy. Depending on the location of the diverticulum on preoperative imaging, the left or right side is selected for surgery. Remove the diverticulum wall and suture the esophageal mucosa, taking care not to remove too much to avoid esophageal stricture. Be careful not to damage the esophagus, and suture it in two layers: mucosa and muscle. If there is an abscess or fistula, it should be resected and repaired together, and the pleura, intercostal muscle and pericardium can be used as reinforcing tissue. Preoperative gastroscopy and angiography see huge esophageal diverticulum Intraoperative and postoperative see diverticulum has been excised and healed