DILATATION OF THE (ESOPHAGUS. 487 



ages to the oesophagus, lying between it and the spine. Such diver- 

 ticuli sometimes only communicate with the oesophagus by a narrow 

 fissure ; in other cases, they seem to be prolongations of the 

 oesophagus itself, with a blind end, which the food enters, while 

 alongside of it the lower part of the oesophagus lies empty, con- 

 stricted, collapsed. JZlebs claims that such a state is rare, and that 

 in most small diverticuli all the coats are found ; that the muscu- 

 lar coat does not disappear till they enlarge. 



SYMPTOMS AND COURSE. Moderate dilatations, that are not due 

 to constriction, do not cause decided symptoms, and are only recog- 

 nized after death ; larger ones, with morbid relaxation of the mus- 

 cular coat, may be accompanied by dysphagia and regurgitation. 

 The diagnosis may be made by introducing an oesophageal sound, 

 and finding it move too freely. The partial dilatation that forms 

 above a contracted part modifies the symptoms, so that the food re- 

 mains in the oesophagus for a longer time and in greater quantities 

 before regurgitating. When the food is finally vomited, it is soft- 

 ened, mixed with mucus, sometimes decomposed, but it is undi- 

 gested and almost always of alkaline reaction. This circumstance 

 may be useful in deciding whether the food comes from the stom- 

 ach or oesophagus. 



When the diverticuli are so large that the food goes into them 

 instead of into the stomach, they excite the same symptoms as stric- 

 ture with partial dilatation. The food that has been swallowed 

 sometimes regurgitates hours afterward, and may then be much de- 

 composed, so that there wilt be a very bad smell from the mouth of 

 the patient ; or it may be but little changed, and may be chewed 

 over and again swallowed (rumination). Occasionally introducing 

 the bougie renders the diagnosis certain, since we may at one time 

 meet an insurmountable obstacle to its passage, while at another it 

 may readily pass the diverticulum, and enter the stomach. If the 

 diverticulum be at the commencement of the oesophagus, a soft 

 tumor may be found in the neck behind the larynx, which increases 

 in size after eating and drinking, and diminishes when the food and 

 drink have been evacuated ; if it be farther down, by pressure on 

 the trachea and great vessels, it may cause dyspnoea and disturb- 

 ance of the circulation. 



[The diverticulum usually goes on increasing gradually for 

 years, and may even progress from childhood to old age. When 

 the sac is of moderate size, it does not threaten life ; when exten- 

 sive, the patient may die of inanition unless sooner killed by dis- 

 turbance of circulation or respiration, or by ulceration and perfo- 

 ration of the walls of the sac. 



