Midthoracic esophageal diverticula.

Periesophageal inflammation, most commonly secondary to tuberculosis, was a frequent cause of midthoracic diverticula. Today, the majority of these diverticula are the result of esophageal motility disorders. Although many patients are asymptomatic, it is the underlying motility disturbances that produce most symptoms. A barium esophagogram is the best study to show midthoracic diverticula. Esophageal manometry may be difficult to perform because of the obstruction of passage of the motility catheter by the diverticulum, but it is useful in defining the cause of the diverticulum and directing therapy. Esophagoscopy is helpful in the assessment of complications or associated esophageal abnormalities. It adds little to the evaluation of the diverticulum. In patients requiring surgery, a diverticulectomy with a myotomy performed on the esophageal wall opposite the diverticulum is the preferred treatment. Lesser procedures have been reported to be successful in select patients.