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Zenker's Diverticulum

  1. Zenker's diverticulum occurs due to increased pressure in the oropharynx during swallowing against a closed upper esophageal sphincter.
  2. Zenker diverticula are an acquired pulsion-type of diverticula (Pseudo diverticula) that form in the posterior hypopharynx because of mucosal layer herniate through a defect in the muscular wall, between the oblique and transverse head of inferior pharyngeal constrictor muscle (Killian triangle).
  3. In traction diverticula extraluminal forces (like inflamed & scarred peribronchial and mediastinal lymph node) pull the full thickness of the esophagus out, creating a true diverticula.
  4. Retention of undigested food in large diverticula occasionally results in regurgitation, nocturnal cough, and aspiration pneumonia.
  5. Most patient are over the age of 50 years. (AIPG 95)
  6. Dysphagia (intermittent) is the most common symptom
  7. Swelling in the neck (usually left lateral), gurgling noises after eating, halitosis
    Imaging Studies: Chest x-rays/ CT scans will show large diverticula of the esophagus and hypopharynx may also manifest as air or fluid-filled structures.
Extra Edge:

Barium swallow is investigation of choice for Zenker diverticulum.
(Endoscopy is contraindicated in Zenker diverticulum – Risk of perforation Q 

Treatment of Zenker’s diverticulum is surgical;
Surgical option include –

  1. Diverticulectomy with cricopharyngeal myotomy,  
  2. Diverticular suspension (diverticulopexy) with cricopharyngeal myotomy,
  3. Cricopharyngeal myotomy alone
  4. Diverticulo esophagostomy using linear cutting staple gun – The septum between the esophagus and divided (Dohlman's procedure Q).
  5. Pneumonia & Lung abscess due to aspiration are the most common complication of Zenker’s
  6. Diverticulam. (AIIMS Nov 96)

a. Complications of surgery include:

  1. Recurrent laryngeal nerve palsy       
  2. Cervical emphysema
  3. Mediastinitis                     
  4. Cutaneous fistula

Description: Click to see larger picture

Barium esophagram, AP view, demonstrating a bilobed Zenker diverticulum

Description: Click to see larger picture

Zenker diverticulum, lateral view

Description: Barium swallow showing a pharyngeal pouch

Barium swallow show residual pool of contrast within the pouch


Points To Remember:

  1. Zenker diverticula are an acquired pulsion-type of diverticulum from Killian triangleQ
  2. Best diagnostic investigation is Ba Swallow
  3. Best treatment is diverticulectomy with cricopharyngeal myotomyQ
  4. Traction diverticula is true diverticula because of mediastonal fibrosis (Tuberculosis).

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