Killian‐Jamieson diverticulum

Abstract

Killian-Jamieson diverticulum (KJD) is rare hypopharyngeal defect. As in other forms of esophageal diverticuli (i.e., Zenker's), recent literature has described minimally invasive endoscopic approaches to its management.1, 2 We present a case of a 62-year-old female with symptoms consistent with an esophageal diverticulum. A barium swallow study was consistent with a KJD. The patient was brought to the operating room and endoscopically examined to confirm the presence of this entity. A open transcervical approach was performed to remove the diverticulum without complication. During our dissection, the recurrent laryngeal nerve (RLN) was noted to be adherent to the base of the diverticulum and needed to be freed prior to performing the diverticulectomy. We provide a review of recent literature and medical illustrations to highlight the importance of the open transcervical approach in the management of KJD to avoid inadvertent transection of the RLN.

Atypical Pharyngeal Pouch Arising Bilaterally between the Hyoid Bone and Thyroid Cartilage

“…An external approach allowed for careful and accurate identification and dissection of the pouches, with preservation of the neurovascular bundle. Undavia et al described an open transcervical approach in the management of patients with a Killian-Jamieson diverticulum, in order to preserve the recurrent laryngeal nerve and other structures and to ultimately decrease morbidity and mortality rates [2]. Kobayashi et al describe an open excision approach along the anterior border of the sternocleidomastoid muscle with subsequent lateral retraction of the carotid sheath to visualise the diverticulum located in Laimer-Haeckerman's triangle below the cricopharyngeus muscle [5].…”

“…By far the most common is Zenker's diverticula, characterised by a posterior outpouching originating from Killian's dehiscence of the inferior constrictor muscle, between the cricopharyngeal and thyropharyngeal muscles. The Killian-Jamieson diverticulum is much rarer and is a herniation through the anterolateral located superolateral to the longitudinal muscle of esophagus and inferior to the cricopharyngeal muscle [2, 3]. The rarest variant of pharyngeal diverticulum is often referred to as Laimer's or Laimer-Haeckerman's diverticulum.…”

“…Similar to the Killian-Jamieson diverticulum, it originates between cricopharyngeus and the longitudinal muscle of the oesophagus; however, it is located posteriorly and midline, from the area termed Laimer-Haeckerman's triangle, and is covered only by the circular muscles of the oesophagus [4–6]. The various subtypes of pharyngoesophageal diverticulum are easily distinguishable with radiographic studies [2]. There have only been 3 reports of Laimer-Haeckerman's diverticuli thus far [4–6].…”

Killian–Jamieson diverticulum: real-time sonographic findings

“…The high intraluminal pressure, which is caused by the inappropriate constriction of the hypopharyngeal muscular fibers during swallowing, produces the herniation in the anatomical area of weakness. Surgical approach is often not recommended, as the most of the patients are asymptomatic [4].…”

“…Although Zenker diverticulum is four times more common than KJD, the latter is more frequently misdiagnosed with a thyroid nodule for its anatomical location [4,5].…”