This is a Barium Swallow taken from 71 years old man who was complaining of  a sensation that foods sticking in the throat and regurgitation of unchanged food few hours after eating which was lasting for about 2 months.His neurological examination was uneventful.

Identify this Barium Swallow?


ANSWER

Zenker Diverticulum or Pharyngoesophageal Diverticulum 


It is a outpouching of the mucosa of the posterior pharyngeal wall through Killian's triangle(also known as Laimer's triangle, and the Killian-Laimer triangle)an area of weakness between the two parts of the inferior pharyngeal constrictor - the thyropharyngeus and the cricopharyngeus - at their posterior margin.Zenker diverticulum has male predominence and is observed almost exclusively in older individuals.


Mechanisms
  • Uncoordinated swallowing
  • Impaired relaxation and spasm of the cricopharyngeus muscle


Zenker diverticula extend into the left neck 90% of the time

CLINICAL FEATURES

  • Dysphagia
  • Palpable swelling in the neck in two-thirds of cases
  • Involuntary gurgling noises when swallowing
  • Halitosis
  • Regurgitation of undigested food hours after eating
  • Sensation of food sticking in the throat
  • Coughing after eating
  • Aspiration of organic material
  • Episodes of pulmonary infection
  • Unexplained weight loss


COMPLICATIONS
  • Aspiration
  • Bleeding from the mucosa
  • Esophageal obstruction
  • Tracheal Fistulation
  • Squamous cell carcinoma - but very rare

INVESTIGATIONS

Barium swallow with videofluoroscopy

TREATMENT

If small and asymptomatic, no treatment is necessary
In symptomatic cases
Excision of the pouch combined with myotomy (longitudinal division - of the cricopharyngeus)
Approaches at the level of the cricoid cartilage or obliquely through the left sternomastoid have been used to excise the pouch
Risks of surgery such as fistula formation, mediastinitis, inhalation pneumonia and recurrent laryngeal nerve damage
Endoscopic stapling performed through a fibreoptic endoscope


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13 comments

  1. Anonymous Says:
  2. Large esophageal diverticulum w/ trapped bolus.

     
  3. dr.sumbal Says:
  4. zenker,s diverticulum...

     
  5. Anonymous Says:
  6. I think it's Zenker's diverticulum

     
  7. Anonymous Says:
  8. ESOPHAGEAL DIVERTICULA
    dr sadia

     
  9. Anonymous Says:
  10. zenkers d.
    dr.basant

     
  11. Anonymous Says:
  12. midline, proximal esophagus:zenker's diverticula

     
  13. Anonymous Says:
  14. arash from iran

    zenker diverticula

    uptodate.com:
    The precise cause of ZD remains unsettled but it occurs in a variety of circumstances predisposing to herniation within Killian's triangle, such as abnormal esophageal motility, esophageal shortening, or disorders associated with UES dysfunction.

    Treatment of patients with Zenker's diverticula should consider the availability of local expertise. Experience is important, regardless of which method is used

    We suggest rigid or flexible endoscopic treatment be considered in centers with a trained endoscopist who has demonstrated favorable outcomes (Grade 2C). Exceptions are young patients with large diverticula

     
  15. Anonymous Says:
  16. I Think It Is Zenker Diverticulom

     
  17. Anonymous Says:
  18. esophageal diverticulum
    dr_islam from sudan

     
  19. sharimi Says:
  20. zenckers diverticulum..halitosis is also usually a common feature cos of stale food lodging in the diverticula..plus or minus iron def anaemia

     
  21. Anonymous Says:
  22. it must be Zenker's diverticulum bcoz the patient is an oldman accompanied by dysphagia and regurgitation of food!!!

     
  23. zenkers diverticulum

     
  24. Danielle Says:
  25. ZENKER DIVERTICULUM! Iactually have now a patient with this =D

     

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