Zenker's diverticulum

Source: Wikipedia, the free encyclopedia.
Not to be confused with Pharyngeal pouch (embryology).
Zenker's diverticulum
Other namesPharyngoesophageal diverticulum, pharyngeal pouch, hypopharyngeal diverticulum
SpecialtyGastroenterology

A Zenker's diverticulum, also pharyngeal pouch, is a

cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus
). It is a pseudo diverticulum or false diverticulum (only involving the mucosa and submucosa of the esophageal wall, not the adventitia), also known as a pulsion diverticulum.

It was named in 1877 after

pathologist Friedrich Albert von Zenker.[1][2]

Signs and symptoms

When there is excessive pressure within the lower

pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum
which may reach several centimetres in diameter.

While traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the

Killian's triangle, located superior to the cricopharyngeus muscle and inferior to the thyropharyngeus muscle. Thyropharyngeus and cricopharyngeus are the superior and inferior parts of inferior constrictor muscle of pharynx respectively). The result is an outpouching of the posterior pharyngeal wall, just above the esophagus.[3]

While it may be asymptomatic, Zenker diverticulum can present with the following symptoms:

  • Dysphagia (difficulty swallowing), and sense of a lump in the throat
  • Food might get trapped in the outpouching, leading to:
    • Regurgitation, reappearance of ingested food in the mouth
    • Cough, due to food regurgitated into the airway
    • Halitosis
      , smelly breath, as stagnant food is digested by microorganisms
    • Infection

It rarely, if ever, causes any pain.

Esophageal webs are seen associated in 50% of patients with this condition.

Rarer forms of cervical esophageal diverticula are the

cricopharyngeus muscle). Laimer's diverticulum
is formed in Laimer's triangle (located inferior to the cricopharyngeus in the posterior midline above the confluence of the longitudinal layer of the superior esophageal circular muscle). Laimer's triangle is covered only by the circular layer of esophageal muscle.

Diagnosis

Lateral X-ray of a Zenker's diverticulum
AP X-ray of a Zenker's diverticulum

A combination of the simple

barium swallow and a thorough endoscopy will normally confirm the diverticulum.[4]

Treatment

If small (ie, <2 cm) and asymptomatic, no treatment is necessary.

cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling[6][7] (i.e. diverticulotomy with staples ). This may be performed through a diverticuloscope. Other methods include fibreoptic diverticular repair.[8]

Other non-surgical treatment modalities also exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.[9]

Epidemiology

Zenker's diverticulum mainly affects older adults. It has an incidence of 2 per 100,000 per year in the UK, but there is significant geographical variation around the world.[10]

References

  1. Who Named It?
  2. ^ Zenker, FA; von Ziemssen, HW (1867). Krankheiten des Oesophagus. Leipzig: F.C.W. Vogel.
  3. S2CID 31405929
    .
  4. PMID 26843913
    .
  5. PMID 29763172
    , retrieved 2023-11-07
  6. S2CID 32002606
    .
  7. S2CID 6206165
    .
  8. S2CID 39747386
    .
  9. S2CID 45791555
    .
  10. PMID 11470929
    .

External links
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