Zenker’s Diverticulum (Pharyngoesophageal Diverticulum, Pharyngeal Pouch, Hypopharyngeal Diverticulum : Definition, Causes, Pathophysiology, Symptoms, & Treatment
Definition
- Zenker’s Diverticulum is a pulsion diverticulum of the hypopharynx where a pouch forms in killian’s triangle just above the cricopharyngeal muscle because of increase in intraluminal pressure.
- Male > Female
- More common in old age.
Etiopathogenesis
Upper esophageal sphincter dysfunction
⇓
Uncoordinated swallowing
⇓
Pressure on an area of the pharynx wall ↑
⇓
Herniation of wall through killian’s triangle (No muscular support)
⇓
Outpouching of the posterior pharyngeal wall
Clinical Features
- Dysphagia (intermittent)
- Regurgitation of old food
- Halitosis (Bad breath)
- Cough
- Aspiration & choking
Note: Causes of intermittent dysphagia are
- Diffuse esophageal spasm (DES) – Most common
- Zenker’s diverticulum
- Schatzki ring
- Eosinophilic esophagitis
Complications
- Choking
- Aspiration pneumonitis → Lung abscess
- Bleeding
- ↑ risk of cancer (by 5%)
Classification
Morton-Bartney’s Classification of diverticula
- Small <2 cm
- Medium 2-4 cm
- Large >4 cm
Diagnosis
- Barium Swallow (Investigation of choice)
Treatment
A. Mild cases
- Lifestyle changes → Wait & Watch Approach
B. Moderate to Severe cases
Open Method
If <2 cm ⇒ Cricopharyngeal myotomy or neurotoxic injection in cricopharyngeus muscle
If 2-4 cm ⇒ Cricopharyngeal myotomy or neurotoxic injection in cricopharyngeus muscle
+
Diverticulopexy
If >4 cm ⇒ Diverticulectomy + Cricopharyngeal Myotomy
Dohlman Procedure (Endoscopic procedure)
- Linear staples (nowadays by CO2 LASER)
- 2-15 cm
Disclaimer: DoctorAlerts is an educational platform. It does not provide medical advice, diagnosis, or treatment. We neither promote nor sell any type of prescription drug or supplement.
