Kilian Jemison Diabeticulum, a rare presentation with food impaction, by Shubham Sood, Amrit Kamboj and Nayanthra Koiloprapu. No Disclosures. Case Presentation. A 40-year-old man with long-standing heartburn, well-controlled on one-steady omeprazole and without prior dysphagia, presented to the emergency department with food impaction. He was otherwise healthy, without any significant comorbidities. The gastroenterology service was consulted, and an urgent EGD was performed in the setting of acute presentation with food impaction. Endoscopic Method. The patient was first intubated by the anesthesia team, a therapeutic endoscope was then inserted. The upper esophageal sphincter was identified and extended from 15 to 17 cm. A non-baiting Kilian Jemison Diabeticulum with a large opening was found in the proximal esophagus, extending from 18 to 20 cm. The Diabeticulum contained a large amount of food, which was carefully removed using a rat-tooth forceps and a soft cap. After food bolus removal, the Diabeticulum was inspected, and the underlying mucosa demonstrated mild status changes, but was otherwise healthy. Contrast was injected, and fluoroscopy confirmed the diagnosis of Kilian Jemison Diabeticulum. Here is a representative image of the impacted food found in the upper esophagus. Now we will review the findings in this post-food removal endoscopic video. Two openings are visible in the upper esophagus, esophageal lumen and the opening of Kilian Jemison Diabeticulum. The underlying mucosa looked healthy, apart from some status changes. No other abnormality was seen in the esophagus. Contrast was injected following tests. Here are the fluoroscopic images showing the Diabeticulum. Case resolution. Patient was dismissed following endoscopy, a referral was arranged for definitive management. Medical Implications. Esophageal diverticula, such as KJ diverticulum, are a rare but well-established cause of dysphagia and food impaction. A KJ diverticulum is located in the hypopharynx and is considered a false pulsant-type diverticulum. While the underlying pathophysiology is not well-established, cricopharyngeal muscle dysfunction may play a role in its development. It is essential to differentiate KJ diverticulum from KJ diverticulum for effective and timely management. KJ diverticulum occurs through a muscular gap in the anterolateral wall of the proximal cervical esophagus. As it is located below the cricopharyngeal muscle, there is less risk of aspiration. In contrast, KJ diverticulum occurs through a muscular gap in the posterior aspect of the proximal cervical esophagus, owing to its location above the cricopharyngeal muscle makes it more prone for aspiration. In patients that are asymptomatic and are incidentally found to have KJ diverticulum, no definitive treatment is required and close outpatient follow-up may be performed. However, in patients with asymptomatic KJ diverticulum, surgical or endoscopic intervention may be required, such as diverticulotomy, diverticulectomy, or diverticulopexy. Protection of the recurrent relative nerve during management is vital as it lies in close proximity to the diverticulum. Conclusions A KJ diverticulum is a rare cause of food impaction and esophageal diverticula should be kept in the differential in a patient presenting with dysphagia. During treatment of a KJ diverticulum, recognition of the recurrent differential nerve is critical to avoid injuring the structure given its proximity to the diverticulum.

food impaction

Kilian Jemison diverticulum

dysphagia

endoscopic intervention

recurrent laryngeal nerve