ESOPHAGUS, Diverticula of.
The form of pouching of the gullet which is due to pressure from within acting upon a congenital local weakness, is caused by abnormal persistence or irregularity in the position of a visceral cleft. It is usually met with amongst those who rapidly bolt their food in large mouthfuls without chewing.
The pouch in these cases is situated near the pharynx, and its exact position and size should be outlined by filling it with Bismuth emulsion and exposing the neck to the X rays, or by Plummer's method of causing the patient to swallow a long skein of silk. When the mouth of the sac is wide and the case comes under early observation, much may be done by reforming the patient's habits as regards feeding. Food should be thoroughly masticated and swallowed in small amounts, or the patient may be fed for a time through a rubber tube passed beyond the pouch into the stomach or fluids may be administered in small amounts by the mouth.
Where the pouch becomes distended with retained food its pressure upon the (esophageal tube may cause a considerable degree of dysphagia and rupture of its walls is liable to occur. These cases are best dealt with
by Butlin's operation, which consists in cutting down upon the diverticu lum as in an ordinary cesophagotomy for an impacted foreign body, dissecting it out and closing the wound in the gullet by a triple row of catgut sutures. As deep cellulitis of the neck is likely to follow this operation it may be done in two stages: (s) Exposure of the diverticu lum; pack the wound for two or three days; (2) complete the operation by removal of diverticulum and suture of oesophageal wall in layers.
Staten divides the neck of the diverticulum with the cautery between a strong catgut ligature and a distal clamp, after which the stump is thoroughly sterilised by the cautery and covered over with the muscular layer of the gullet by catgut sutures.