A 57-year-old Caucasian woman was admitted to our surgical department. She complained of persistent nagging epigastric pain and pain behind the sternum, in the left hypochondrium, constant heartburn, belching, daily vomiting of eaten food and liquid, impaired swallowing, fever up to 39  C. The woman had no previous medical or surgical history.
The preoperative study included esophagogastroduodenoscopy (EGD), barium swallow esophagoscopy and chest spiral computed tomography (CT) scan. EGD revealed large pouch of the right esophageal wall in middle and lower third of the esophagus with signs of inflammation, ulceration and necrosis and retained food in the pouch. Barium esophagogram demonstrated 50 x 100 mm epiphrenic diverticulum on the right side and in the lower third of the esophagus which contained food (Fig. 1). CT scan confirmed the diagnosis, showing 77 x 53 mm diverticulum in the lower third of the esophagus. Complete blood count (CBC) revealed leukocytosis along with "left upper shift" and increased erythrocyte sedimentation rate (ESR).
Considering esophageal wall necrosis extended more than 70 mm, the setting of the esophageal stent was inappropriate. Thereby, it was decided to perform laparoscopic-thoracoscopic esophageal resection (Ivor Lewis operation). The time from the moment of admission to the hospital until the operative treatment was 2 days.