Epiphrenic diverticulum of the oesophagus complicated by the impaction of a foreign body.

A 49-year-old woman from Trichur, Kerala, reported on March 7, 1961, and complained of severe dysphagia of a week's duration. This started after she had eaten a meal which included mutton curry. The dysphagia was less severe two days later after she had regurgitated some food containing pieces of mutton. She could swallow liquids at the time of admission to hospital. She was known to have been a slow eater since childhood. She had actually felt dysphagia for solids, and had recently formed the habit of macerating her food (mainly rice) in buttermilk or milk to facilitate swallowing. She never had pain or vomiting. Apart from evidence of loss in weight and a mild anaemia, there was no other significant clinical finding. Fluoroscopic examination with a barium swallow showed narrowing of the lowest 5 cm. of the oesophagus with a small diverticulum arising from the middle of the narrowed segment and projecting to the left. The diverticulum measured 2 cm. in diameter and 1.5 cm. in length; the neck or mouth was 0.7 cm. across (Fig. 1). The barium emptied from the diverticulum slowly. A foreign body inside was not suspected pre-operatively. Barium was held up in the oesophagus itself above the narrowed segment. Oesophagoscopy showed proximal dilatation filled with food debris. The mucous membrane was pale and smooth. Lower down, marked " spasm " made examination of the diverticulum impossible. The patient was given 350 ml. of blood to correct the anaemia and was operated on on March 15, 1961. A left thoracotomy was carried out through the bed of the seventh rib and the pulmonary ligament was