So wowɔ kotoku ketewaa bi wɔ wo menewam? (Esophageal Diverticulum) a ɛwɔ nipadua no mu?

Ɛtɔ mmere bi a, wote nka sɛ biribi akɔhyɛ wo menewam bere a womene aduan no? Anaasɛ hua bɔne bi fi w’anom kɛkɛ? Eyinom betumi ayɛ tebea bi a wɔfrɛ no esophageal diverticulum, a yɛbɛka ho asɛm nnɛ no ho sɛnkyerɛnne. Mma ɛnhaw wo, ɛnyɛ nea abu so saa. Nanso eye sɛ wubehu ho asɛm kakra. Momma yɛnka ho asɛm tiawa, wɔ ɔkwan a wubetumi ate ase so.

Dɛn ne saa kotoku ketewa yi a ɛwɔ aduan mu (Esophageal Diverticulum)?

Okay, di kan ma yɛnhwɛ nea eyi (Esophageal Diverticulum) yɛ. Wunim, yɛwɔ afiri bi a ɛde aduan fi yɛn anom kɔ yɛn yafunu mu, yɛfrɛ no esophagus . Ɛte sɛ nsu paipu, nanso wɔde ntini na ɛyɛ. Wɔ saa aduan paipu yi mu no, ɛtɔ mmere bi a epue fi mmeae a ɛyɛ mmerɛw wɔ ɔfasu no mu, na ɛyɛ biribi te sɛ kotoku ketewaa bi, anaa kotoku ketewaa bi. Ɛno nti na yɛfrɛ no eyi. Fa no sɛ kar tae a ɛyɛ dedaw na ɛbɔ kakra wɔ baabi biako. Saa na eyi te.

Nkotoku nketewa yi ahorow abien na ɛwɔ hɔ.

• ‘Nokware’ kotoku: Eyi kyerɛ sɛ aduannuru no fasu no nyinaa , a ntini a ɛwɔ mu no ka ho, apue.
• ‘Atoro’ kotoku: Eyi ne bere a ɔfasu no mu nsensanee bi te sɛ ntini ne ntini a ɛwɔ ase (submucosa) nkutoo na ɛpuepue. Ɛte sɛ nea wɔtwe ntama nhama kakraa bi pɛ fi mu.

Nnuruyɛfo gyina baabi a ɛwɔ wɔ aduan mu no so hu saa akisikuru yi. Nea ɛde akisikuru ba wɔ mmeae ahorow no betumi ayɛ soronko.

Dɛn ne esophageal diverticulum ahorow?

Ma yɛnhwɛ nea ɛyɛ ahorow atitiriw a wobetumi ahu.

Zenker a ɔyɛ diverticulum no

Eyi ne ɔkwan a ɛtaa ba . Ɛba wɔ esophagus no atifi, baabi a menewa no ne ano hyia no. Mpɛn pii no, eyinom yɛ ‘atoro’ nkotoku. Nea enti titiriw ne sɛ , sɛ ɛyɛ den sɛ wɔbɛmene aduan , sɛ menewa mu ntini no ntumi nyɛ adwuma yiye a, nhyɛso a ɛwɔ aduan no mu no kɔ soro na ɛpia no fa baabi a ɛyɛ mmerɛw fi adi. Fa no sɛ nsu paipu bi asiw baabi, na sɛ nsu no ba ntɛmntɛm a, paipu no hohoro ansa na baabi a asiw no aba.

Killian-Jamieson Nneɛma a Wɔde Di Dwuma Diverticulum

Eyi nyɛ nea abu so kakra. Ɛba wɔ awotwaa mu aduannuru, yɛn kɔn no fã a ɛne akyi berɛmo no di nsɛ no mu. Wɔtaa hu no sɛ ‘atoro’ kotoku biako pɛ. Wosusuw sɛ efi awo mu mmerɛwyɛ bi a ɛwɔ ntini a ɛwɔ saa beae no mu.

Midesophageal Diverticulum a Ɛwɔ Anom Ntini Mu

Eyinom yɛ ‘nokware’ nkotoku. Wɔyɛ wɔ esophaguus no fã a ɛfa yɛn koko mfinimfini no mu. Wɔsan frɛ wɔn (thoracic diverticula) , a ɛkyerɛ sɛ wɔyɛ wɔ koko mu. Ɛtɔ da bi a wɔfrɛ wɔn (traction diverticula).Nea enti a ɛte saa ne sɛ ɛba bere a abɔnten so tumi bi twetwe aduan no fasu (traction) no. Sɛ nhwɛso no, ntini a ɛwɔ koko mu no betumi ahonhon na abata aduannoa no ho, na afei sɛ ahonhon no brɛ ase a, ɛwo no fasu no tumi twe.

Epiphrenic Diverticulum a ɛma obi ho yɛ hyew

Eyi ba wɔ aduan no awiei, ansa na aduan no akɔ yafunu no mu (distal esophagus). Eyinom taa yɛ ‘atoro’ nkotoku. Ɛha nso, nea ɛde ba ne nhyɛso. Sɛ nhwɛso no, sɛ wɔasiw aduan no fã a ɛwɔ fam no a, kotoku no betumi ayɛ esiane nhyɛso a ɛba bere a aduan bɔ mmɔden sɛ ɛbɛfa mu akɔ yafunu no mu nti.

Saa tebea yi abu so dɛn?

Esophageal diverticula ho yɛ na ankasa . Wosusuw sɛ ɛka nnipa dodow bɛyɛ 1% pɛ . Wɔtaa ba nnipa a wɔadi boro mfe 50 so , titiriw bere a wɔadi mfe 70. Ɛtaa ba mmarima so kakra nso sen mmea.

Dɛn ne sɛnkyerɛnne ahorow a ɛkyerɛ sɛ obi anya esophageal diverticulum?

Mpɛn pii no, saa diverticula ahorow yi mfa sɛnkyerɛnne biara mma . Ebia wunnim mpo sɛ wowɔ bi. Nanso, ɔkwan bi a wɔfrɛ no Zenker diverticulum no taa de sɛnkyerɛnne ahorow ba. Sɛ wowɔ saa sɛnkyerɛnne ahorow yi a, ebia wubenya:

• Ɛte sɛ ɔfe a ɛyɛ mmerɛw wɔ menewam.
• Sɛ wote nka sɛ akuru bi wɔ wo menewam bere a womene aduan no.
• Nkate a ɛte sɛ nea aduan akɔhyɛ menewam.
• Aduan san ba soro kɔ menewa no mu (regurgitation) bere a woakotow akɔ w’anim anaasɛ woada fam no.
• Ahome bɔne a ntease biara nnim.
• Ahomegye yɛ nnyigyei a ɛyɛ abɛn bere a ɔrehome a ntease biara nnim no.

Nnipa binom nni saa sɛnkyerɛnne ahorow yi mu biara na wohu no kwa bere a wɔreyɛ nhwehwɛmu bi esiane biribi foforo nti.

Dɛn na ɛde esophageal diverticulum ba?

Nneɛma atitiriw abien na ɛde ba. Baako yɛ nea ɛde pulsion ba, na biako nso yɛ nea ɛde traction ba.

Pulsion pouches: Esophageal pouches dodow no ara hyɛ saa kuw yi mu. 'Pulsion' kyerɛ sɛ "ɔpiapia." Eyi kyerɛ sɛ nhyɛso a ɛkɔ so wɔ nipadua no mu wɔ aduan no mu. Eyi taa ba bere a yɛmene aduan no. Ayaresa mu tebea horow bi a ɛwɔ aduan mu a ɛma ɛyɛ den sɛ wɔbɛmene aduan no betumi de nhyɛso a ɛnteɛ yi aba. Nhwɛsoɔ:

• (Achalasia) (ntini a ɛwɔ aduan a ɛwɔ fam no ntumi nnya ahotɔ) .
• Esophageal a ɛyɛ mmerɛw
• Esophageal a ɛyɛ den
• Eosinophilic aduan mu yare

Nkotoku a wɔde twe ade:Eyinom ba bere a biribi twetwe aduan no fasu no akyi na ɛtwe no. Eyi na ɛde nkotoku ‘nokware’ a ɛyɛ aduannoa mu ɔfasu a wɔtwe kɔ mu no nyinaa mu duru ba. Eyinom taa hu wɔ koko no mfinimfini. Ɔyare mmoawa a ɛwɔ koko mu (mediastinitis) betumi ama obi ho ahon, na ebetumi abata aduannoa no ho, na afei atwe aduannoa no bere a ɔfe no kɔ fam no. Nyarewa a ɛtete saa ho nhwɛso bi ne:

• Nsanyare a ɛma obi nya nsamanwaw
• Histoplasmosis , ɔyare mmoawa a efi fungal mu

Nneɛma abien a ɛde ba yi nyinaa yɛ nkɔso foforo a ɛba yɛn nkwa nna mu. Ɛntaa mma sɛ akyi berɛmo kotoku bi betumi aba bere a wɔawo no. Anaasɛ, mmerɛwyɛ a efi awo mu wɔ akyi berɛmo no mu ntini mu no betumi ama ayɛ mmerɛw sɛ kotoku bi benyin akyiri yi. Nanso mpɛn pii no, saa kotoku yi ntumi nkɔ so gye sɛ aduruyɛ mu tebea foforo di kan ba.

Dɛn ne nsɛnnennen a ebetumi aba wɔ saa aduan a ɛkɔ nipadua no mu yi mu?

Bere a saa kotoku yi yɛ kɛse bere kɔ so no, ɛda adi sɛ aduan bɛkɔ mu . Eyi betumi ayɛ te sɛ akisikuru wɔ wo menewam, anaasɛ ebetumi anya ɔyare mmoawa na ayɛ wo yaw . Aduan a ɛkyekyere no betumi ama w’anom ahua na ayɛ dɛ bɔne wɔ w’anom. Sɛ enya ɔyare no a, ebetumi atu mogya na ahuru. Wɔ tebea horow a emu yɛ den mu no, ebetumi ayɛ te sɛ akisikuru a wubetumi ate nka wɔ wo kɔn akyi.

Ade foforo ne sɛ aduan betumi atra hɔ kakra na afei asan aba soro akɔ menewam bere a woasesa wo gyinabea (sɛ nhwɛso no, bere a woakotow no). Eyi betumi ama wafefe, ne home ayɛ no yaw, na ne menewa mu ayɛ no yaw. Sɛ eyi ba anadwo bere a woada a, aduan mu nneɛma nketenkete no betumi akɔ ahurututu no mu a wunhu (silent aspiration) . Sɛ eyi ba a, ebetumi ama ɔyare mmoawa aba ahurututu no mu (aspiration pneumonia) . Eyi taa ba nnipa a wɔwɔ Zenker diverticulum no mu.

So eyi yɛ kokoram? So ebetumi ayɛ kokoram?

Wɔahu sɛ nnipa a wɔwɔ esophageal diverticulum no mu ɔha biara mu kakraa bi pɛ (bɛyɛ 0.05%) nya squamous cell carcinoma of the esophagus. Nanso, wonnya nhuu sɛ ebia eyi yɛ nea ɛbae ara kwa anaasɛ abufuw a enni sabea a efi diverticulum no mu na ɛde kokoram no ba. Nanso, asiane yi sua koraa .

Wobɛyɛ dɛn ahu sɛ wowɔ esophageal diverticulum anaa?

Aduruyɛ mu nhwehwɛmu a ɛhwɛ aduan no mu no betumi ahu kotoku yi. Mpɛn pii no, wonni sɛnkyerɛnne biara, enti wohu wɔ akwanhyia mu bere a wɔreyɛ nhwehwɛmu esiane biribi foforo nti. Sɛ wowɔ sɛnkyerɛnne ahorow a ɛfa wo menewam ho a, wo duruyɛfo bɛyɛ nhwehwɛmu bi a wɔfrɛ no radiology anaa endoscopy. Bere a radiology twa mfonini fi abɔnten no, endoscopy de mfoninitwa afiri di dwuma de hwɛ mu.

Sɔhwɛ ahorow bɛn na wɔbɛyɛ?

Sɔhwɛ ahorow bi a ebetumi aba ni:

• Esophagram / Barium Mene Ho Nhwehwɛmu:

Eyi yɛ X-ray bi. Wɔtwe video (fluoroscopy) a ɛkyerɛ wo menewam bere a woremene no. Wɔ eyi mu no, wɔma wo nsu bi a ɛte sɛ chalk a wɔfrɛ no barium sɛ nom. Ɛkata wo esophagus no mu. Afei, wɔyɛ X-ray bere a woremene no. Eyi ma wuhu sɛnea wo menewam no te, ɔkwan a aduan fa so, ne nkotoku biara a ebia ɛwɔ hɔ no pefee.

• Atifi Endoscopy / EGD Sɔhwɛ:

Wɔ eyi mu no, wɔde afiri tenten bi a mfoninitwa afiri ketewaa bi a wɔfrɛ no endoscope wom fa ano no mu na ɛfa aduan no mu kɔ yafunu no mu. Wɔbɛma wo aduru a ɛma wo ho dwo wo wɔ saa bere yi mu, enti worente nka sɛ wo ho nyɛ wo dɛ. Wobetumi ahwɛ mfonini ahorow a efi mfoninitwa afiri no mu no wɔ kɔmputa so. Sɛ kotoku bi wɔ hɔ a, wobetumi ahu no tẽẽ.

• Esophageal Manometry Sɔhwɛ a Wɔde Hwɛ:

Esiane sɛ ɛyɛ den sɛ mɛmene ade titiriw a ɛde anom nkotoku ba nti, ebia w’aduruyɛfo kuw no nso bɛkyerɛ sɛ wɔyɛ nhwehwɛmu yi. Eyi kyerɛ sɛnea wo menewa mu ntini no twetwe denneennen bere a womene no. Wɔde sensor ahorow a ɛwɔ afiri bi a wɔde fa wo hwene mu na ɛkɔ wo menewam so na ɛyɛ saa susuw yi.

Dɛn ne ayaresa ahorow a wɔde sa esophageal diverticulum?

Nkotoku dodow no ara a ɛwɔ awotwaa mu no nhia ayaresa . Sɛ wɔmfa sɛnkyerɛnne anaa nsɛnnennen biara mma a, wobetumi agyaw wɔn nkutoo. Nanso, sɛ kotoku no de sɛnkyerɛnne anaa nsɛnnennen reba a, ebia ebehia sɛ wɔto mu anaa woyi fi hɔ. Nnuruyɛfo wɔ akwan horow a wɔfa so yɛ eyi. Ebia ɛho behia nso sɛ wosa tebea a ɛwɔ ase a ɛde wo scrotal kotoku no bae no.

Ɔkwan bɛn so na wɔsa esophageal diverticulum?

Oduruyɛfo betumi ayɛ eyi denam oprehyɛn anaasɛ endoscopy so. Ebia akwan horow bɛyɛ papa ama nkotoku ahorow. Wo duruyɛfo begyina w’akwahosan nyinaa so asi ɔkwan a eye ma wo ho gyinae. Sɛ nhwɛso no, sɛ wopɛ sɛ wɔyɛ oprehyɛn a ɛnyɛ den pii a, ebia endoscopy bɛyɛ ɔkwan pa a wobɛfa so. Wo duruyɛfo bɛka asiane ne mfaso a ɛwɔ ɔkwan biara so ho asɛm akyerɛ wo.

Oprehyɛn a Wɔde Siesie Nneɛma

Oduruyɛfo a ɔyɛ oprehyɛn betumi atwitwa kotoku no koraa (diverticulectomy) anaasɛ watwe akɔ soro na wasan apam akɔ wo menewam fasu ho (diverticulopexy) . Ebia oprehyɛn no nso bɛfa ɔkwan bi a wɔfrɛ no myotomy ho . Myotomy yɛ ɔkwan a wɔfa so twa ntini bi a ɛwɔ wo menewam no mu na ama nea ɛyɛ den no so atew. Ebia eyi ho behia na aboa ma ɛyɛ den sɛ wobɛmene a ɛmaa wo kotoku no yɛɛ no.

Endoscopic Diverticulotomy a Wɔde Yɛ Adwuma

Ɔkwan foforo a wobetumi afa so ayɛ oprehyɛn ne sɛ wɔde endoscope bɛfa ano no mu akɔ aduan no mu na wɔafa so ayɛ oprehyɛn no. Wɔfrɛ eyi Dohlman nhyehyɛe.Nea ɛka eyi ho ne sɛ wobetwitwa septum a ɛda kotoku no ne aduannuru no fasu foforo no ntam. Wobetumi de laser, electrocautery, anaa stapler ayɛ eyi. Saa mfiri yi tumi twa kuru no na ɛkata so.

Bere tenten ahe na egye ansa na obi ho atɔ no wɔ oprehyɛn yi akyi?

Ɛho behia sɛ wotra ayaresabea hɔ bɛyɛ da koro. Afei ebehia sɛ wohome wɔ fie adapɛn kakraa bi. Ebia wo menewa bɛyɛ yaw na ɛho ahonhon adapɛn kakraa bi. Eyi betumi ama ayɛ den sɛ wobɛmene aduan. Ebia wɔbɛkamfo akyerɛ sɛ wɔmfa ɛyaw ano brɛ ase, nanso ebia ɛho renhia. Wo duruyɛfo bɛtu wo fo wɔ ɔkwan ne bere a ɛsɛ sɛ wufi ase de nnuan a ɛyɛ nsu di dwuma, na wode nkakrankakra akɔ nnuan a ɛyɛ mmerɛw so, na afei woakɔ nnuan a wodi daa so.

Dɛn ne asɛm a etwa to a woka wɔ tebea yi ho?

Nnipa dodow no ara wɔ esophageal diverticulum na ɛmfa ɔhaw biara mma . Nanso sɛ ɛba saa a, akwan pii wɔ hɔ a wobetumi afa so asiesie. Oprehyɛn ahorow yi nkonimdi boro 90% . Nanso, asiane 10% wɔ hɔ sɛ nsɛnnennen te sɛ mogya a ɛbɛtɔ, ɔyare mmoawa, anaasɛ ɛwo a ɛbɛsɛe aduan no. Wo nnuruyɛfo kuw no ne wo mmiako mmiako asusuw asiane ne mfaso a ɛwɔ ayaresa ahorow a wobetumi apaw so no ho.

Sɛ wowɔ tebea bi a ɛma ɛyɛ den ma wo sɛ wobɛmene a, ebia wubenya kotoku a ɛte sɛ eyi wɔ wo menewa no fasu mu. Saa kotoku yi betumi ayɛ wɔ baabi a ɛyɛ mmerɛw wɔ wo menewa mu esiane nhyɛso a ɛnteɛ a ɛba bere a womene no nti. Ebia ɛrenhaw wo da. Nanso sɛ wunya sɛnkyerɛnne foforo biara a ɛfa wo menewam ho a, kɔ oduruyɛfo nkyɛn. Saa kwan no so no, wobetumi ahu pɛpɛɛpɛ sɛ ɛyɛ kotoku anaa biribi foforo na wɔama wo ayaresa a ɛho hia.

Nneɛma a ɛho hia a ɛsɛ sɛ wokae (Take-Home Message) .

• Esophageal diverticulum yɛ kotoku ketewaa bi a ɛba wɔ esophageal fasu mu.
• Eyinom ho yɛ na koraa na mpɛn pii no ɛnkyerɛ yare no ho sɛnkyerɛnne.
• Sɛ sɛnkyerɛnne ahorow no ba ampa a, ebia nea ɛka ho ne sɛ ɛyɛ den sɛ ɔbɛmene, aduan a ɛbɛkyere ne menewam, ne ahome a ɛyɛ hu.
• Mpɛn pii no, eyinom nhia ayaresa .
• Nanso, sɛ yare no ho sɛnkyerɛnne no mu yɛ den anaasɛ nsɛnnennen ba a, wobetumi ayɛ oprehyɛn anaa endoscopic ayaresa no yiye.
• Ɛho hia sɛ wohwehwɛ aduruyɛfo afotu sɛ ɛyɛ den ma wo sɛ wobɛmene anaasɛ wowɔ sɛnkyerɛnne foforo a. Mma ɛnhaw wo, nnuruyɛfo wɔ hɔ sɛ wɔbɛboa wo.

Mewɔ anidaso sɛ saa nsɛm yi ho bɛba wo mfaso. Kɔ so nya apɔwmuden!

` Esophagus, esophageal, diverticulum, ɛyɛ den sɛ wobɛmene, menewa mu yaw, reflux, endoscopy