P4014 - Kommerell Diverticulum as a Rare Cause of Adult Esophageal Dysphagia

Award: Presidential Poster Award

Akram Ahmad, MD¹, Mary Parianos, MD², Isabella Suarez Alcala, MD³, Adrianna Wierzbicka, MD¹, Zaid Ansari, MD⁴, Albert Parlade, MD¹, Cedric Sheffield, MD¹, Andrew Ukleja, MD^1
1Cleveland Clinic Florida, Weston, FL; ²Holy Cross Hospital, Fort Lauderdale, FL; ³Palmetto General Hospital, Hialeah, FL; ⁴Cleveland Clinic Florida, Plantation, FL

Introduction: Structural esophageal abnormalities are typically the initial focus in evaluating esophageal dysphagia. Infrequent etiologies include cardiovascular anomalies, vascular rings, significant atherosclerosis or aneurysm, and a congenital anomaly of the right subclavian artery causing esophageal compression. This report describes a rare case of dysphagia lusoria from Kommerell diverticulum, a bulbous dilation of the subclavian artery.

Case Description/Methods: An 80-year-old female with a past medical history of mild gastroparesis and hypertension sought evaluation for food aversion, dysphagia to solids and liquids, and 10-pound weight loss. She denied other gastrointestinal symptoms. Her dietary adjustments included smaller, more frequent meals and increased fluid intake. A remote esophagoduodenoscopy six years ago showed only mild gastritis. The barium esophagogram revealed an extrinsic compression of the proximal thoracic esophagus near the aortic arch and held off the barium pill. Subsequent computed tomography (CT) of the chest without contrast revealed an aberrant right subclavian artery with a retro-esophageal course and diverticulum of Kommerell of 1.9 cm. A CT angiography of the chest identified a left-sided aortic arch with aberrant origin of the right subclavian artery, dilated 1.7 cm behind the esophagus, prompting referral for surgical intervention. The patient underwent surgery, right thoracotomy with resection of the vascular ring, right carotid subclavian bypass, and percutaneous thoracic stent placement using endograft. The patient’s symptoms of dysphagia resolved after surgery.

Discussion: Kommerell diverticulum is a rare cause of esophageal dysphagia, resulting from a congenital anomaly with an aberrant course of the right subclavian artery and the development of an aneurysm at its origin. Symptoms can arise from the compression of the trachea or esophagus depending on the aneurysm's size or anatomical path. Our patient's progressive symptoms were due to posterior extrinsic compression by the Kommerell diverticulum. Surgery was necessary to correct the underlying condition. While surgical repair often involves resection of the aneurysm and revascularization, including bypass grafting, it carries significant risks. Therefore, establishing standardized guidelines for surgical intervention and assessing the risks versus benefits of observation are crucial. Surgery was highly successful in this case.









Disclosures:


Akram Ahmad, MD¹, Mary Parianos, MD², Isabella Suarez Alcala, MD³, Adrianna Wierzbicka, MD¹, Zaid Ansari, MD⁴, Albert Parlade, MD¹, Cedric Sheffield, MD¹, Andrew Ukleja, MD¹. P4014 - Kommerell Diverticulum as a Rare Cause of Adult Esophageal Dysphagia, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.