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Pharyngeal Pouches

  1. Types are:
    1. Congenital Diverticulum; Is covered by all the muscles layers of the viscus. e.g. meckels diverticulum’s
    2. Acquired diverticulum: Is a circumscribed pouch caused by protrusion of the mucosa through layers of the wall of an organ
    3. Pharyngo-oesophageal diverticula arise above the crico pharynx: Most commonly arises above the crico pharynx.
  2. Anatomy;                                                          
    1. Constrictors
The weak areas of the pharynx through which the diverticula may from:
  1. Posterior
    1. Killian’s Dehiscence (b/w thyropharyngeus & cricopharyngeus)
    2. Laimer- Hickman’s area (in the upper posterior part of the oesophagus, Just below the crico pharynx where the longitudinal fibers do not cover the circular fibers)
  2. Lateral:
    1. Above the superior constrictor
    2. B/W the superior and the middle
    3. B/W the middle and the inferior constrictor
    4. Below the cricopharyngeus (Killian - Jamieson’s area)
  1. Zenker’s Diverticula: (Posterior pharyngeal pulsion diverticulum)
    1. Site of origin: Killian’s Dehiscence area
    2. Etiology: Theories
      1. Tonic spasm of the cricopharyngeus
      2. Lack of inhibitory stimuli to the crico pharynx
      3. Premature conditions during the act of deglutition
      4. Neuromuscular incoordination and congenital weakness
    3. Features:
      1. Seen after 60 years of age
      2. Male: Female = 2:1
      3. Dysphagia
      4. Feeling of food sticking in the throating difficulty to swallow solids & followed by semisolids ànd then liquids
      5. Regurgitation of food (undigested food- in the mouth)
      6. Weight loss
      7. Hoarseness: (Sac contents in the larynx- Laryngitis)
      8. Pulmonary complications: - (Pneumonitis, bronchiectasis, lung, abscess)
Signs : Boyce’s sign:
  1. Soft swelling on the left side
  2. In the lower part of the anterior triangle which gurgles on palpation
  1. Investigation :
    1. Video - Fluoroscopy
    2. USG
    3. Oesophagoscopy
      1. Treatment:
        1. No treatment: if the general condition of the patient is poor
        2. Endoscopic treatment:
        3. Dilatation of the sphincter (temporal relief)
        4. Endoscopic diathermy of the diverticulo - oesophageal septum (Dohlman’s operation)
        5. External surgical approach: Pouch excision & cricopharyngeal myotomy
  2. Carcinoma of the Diverticulum:
    1. 0.5-1%
    2. Male: Female=5:1
    3. Average duration of symptoms: After 7 years
    4. Treatment: Diverticulectomy F/B radiotherapy

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