Zenker’s diverticulum complicating achalasia: a ‘cup-and-spill’ oesophagus

Abstract

SUMMARYA 72-year-old woman presented with long-standing gastro-oesophageal reflux, regurgitation of swallowed food and worsening cervical dysphagia. Fluoroscopic barium oesophagography revealed a posterolateral pharyngeal pouch (Zenker's diverticulum (ZD)) complicating a 'cup and spill' oesophageal deformity with a smoothly tapered segment at the gastrooesophageal junction. CT and high-resolution manometry confirmed that the underlying abnormality was a massively dilated oesophagus with aperistalsis and pan-oesophageal pressurisation, consistent with a diagnosis of oesophageal achalasia (type II). She underwent endoscopic stapled diverticulotomy, with good symptomatic relief. We discuss the aetiology of ZD, its management and the association here with oesophageal achalasia. BACKGROUND

A Case of Zenker’s Diverticulum in a Patient with Tight Esophageal Peptic Stricture

“…23 The hypothesis of distal esophageal obstruction and increased intraluminal pressure may also explain, at least partially, the association reported between ZD and esophageal achalasia. 24,25 In achalasia, however, esophageal aperistalsis also suggests obstruction at the UES level.…”