Zenker's Diverticulum: Diagnostic Approach and Surgical Management

Abstract

Zenker's diverticulum (ZD), also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2-6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up.

Nursing approach to Zenker’s diverticulum surgery patient

“…In our case study, upper gastrointestinal-endoscopy and thorax CT were diagnosed, 1,[12][13][14] The treatment of Zenker's diverticulum can be done surgically, and the surgery can be performed with an open incision or with endoscopic methods. In our case, the surgery was performed to open-cervical incision, myotomy and thoraco-abdominal stapler.…”

“…A non-progressive filling defect or loss of the smooth contour of the interior of the pouch should raise suspicion of a carcinoma. 1,[14][15][16][17] Esophagogastroduodenoscopy is not necessary to confirm the diagnosis of ZD, but it serves to rule out malignancy in the pouch and to exclude other conditions responsible for the patient's symptoms, such as reflux esophagitis or tumors. 1,14 Ultrasonography as a diagnostic modality for ZD may also be useful in elderly patients who cannot tolerate barium esophagography and in those with a neck mass on physical examination.…”

Mujer de 91 años con obstrucción esofágica por divertículo de Zenker

“…1,2 Zenker's diverticulum (ZD), also called cricopharyngeal, pharyngoesophageal, or hypopharyngeal diverticulum, is a pouch containing only the mucosa and submucosa layers (false diverticulum) at the pharyngoesophageal junction. [1][2][3][4][5][6][7][8][9][10][11][12] This pulsion diverticulum occurs dorsally in the pharyngoesophageal wall, between the inferior constrictor muscle of the pharynx and the cricopharyngeal muscle, an area of relative weakness known as the Killian triangle or Killian dehiscence. [1][2][3][4][5][6][7][8][9][10][11][12] The annual incidence .of symptomatic ZD in the United Kingdom was estimated at two cases per 100,000 population, mainly in males, from middle age to the 9th decade of life.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] This pulsion diverticulum occurs dorsally in the pharyngoesophageal wall, between the inferior constrictor muscle of the pharynx and the cricopharyngeal muscle, an area of relative weakness known as the Killian triangle or Killian dehiscence. [1][2][3][4][5][6][7][8][9][10][11][12] The annual incidence .of symptomatic ZD in the United Kingdom was estimated at two cases per 100,000 population, mainly in males, from middle age to the 9th decade of life. 1,2,[7][8][9][10][11] This condition was described by the first time by Ludlow in 1767, and in 1877 Zenker reported the association of this diverticulum with the upper esophageal sphincter dysfunction.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] The annual incidence .of symptomatic ZD in the United Kingdom was estimated at two cases per 100,000 population, mainly in males, from middle age to the 9th decade of life. 1,2,[7][8][9][10][11] This condition was described by the first time by Ludlow in 1767, and in 1877 Zenker reported the association of this diverticulum with the upper esophageal sphincter dysfunction. 1,2,4,6,7,10 ZD has been more frequently found in Northern Europe, North America and Australia in comparison with Southern Europe, Japan or Indonesia.…”