Zenker`s Diverticulum - the UNC Department of Medicine
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Transcript Zenker`s Diverticulum - the UNC Department of Medicine
Posterior Diverticulum with the neck
originating at a site proximal to the Upper
esophageal sphincter
First described by Ludlow in 1767, named for
Zenker and von Ziemssen who reviewed the
world literature in 1877
Annual incidence of 2 per 100,000
Usually present in age >60
Often age >75
Male predominance
Unclear reason for this
Etiology not entirely clear:
Increased pressures while swallowing, leading to
outpouching through naturally weak area of
esophagus (Killian’s triangle)
Resistance to swallowing due to abnormalities of the
UES
High association with dysphagia (even after repair)
Acid induced esphageal dysmotility
Associated with Barrett’s esophagus in 15-20%
Associated with increased rate of Hiatal Hernia
Halitosis
Regurgitation of undigested food eaten up to
48 hours prior
Cough
Dysphagia
Aspiration
Gurgling in the throat
Appearance of a neck mass
Chronically: Severe cachexia, recurrent
Pneumonias
Usually diagnosed with Barium Study
Entire first glass of barrium can fit in diverticulum if
large and may be confused with esophageal
obstruction
Second diverticulum present in 1-2%
May miss small diverticulum if superimposed in
plane with barium column
Helps to rotate the patient during exam to avoid this
Endoscopy
Less often used due to possibility of perforation,
however this is rare
May find retained pills, food, saliva.
Must use a forward viewing scope to avoid
perforation
Side viewing scopes should be passed over a wire after
direct forward visualization
Manometry
Rarely required in patients with Zenker’s
May help with determining pathogenesis of the
diverticulum
Associated condidtions
Achalasia
Esophageal dysmotility
Increased pharyngeal pressures during swallowing
Mainstay of treatement is surgical
Open resection
Cricopharyngeal myotomy with diverticulectomy
Cricopharyngeal myotomy without diverticulectomy
One stage excision
2 stage mobilization and then excision at later stage.
Endoscopic
Cutting through the common wall of the diverticulum
and esophagus
Aspiration Pneumonia
And all of the complications of pneumonia
Carcinoma of the diverticulum
Ulceration and bleeding of diverticulum if
retained aspirin
Perforation of diverticulum
Pneumomediastinum
Mediastinitis
Severe malnutrition – cachexia
Our patient’s main presentation was that of
respiratory distress and cachexia.
For all intents and purposes he presented the
same way one would expect Advanced Lung
cancer to present.
Only later did the dysphagia and regurgitation
come to light.
Harrison’s internal Medicine pg. 1854
Up to Date – article on Zenker’s Diverticulum
van Overbeek JJ. Pathogenesis and methods of
treatment of Zenker’s diverticulum. Ann Otol
Rhinol Laryngol 2003;112:583-593.