Zenker Diverticulum

  • Esophageal Diverticulum
    • Outpouching of the esophageal mucosa that protrudes through a defect in the tunica muscularis.(MCQ)
    • May be either a true diverticulum, involving all three layers of the esophagus, or a false diverticulum, involving only the mucosa and sub- mucosa.
    • Characterized by its location:
      • Pharyngoesophageal (Zenker’s diverticulum) (MCQ)
      • epiphrenic.
      • midesophageal
    • Pulsion diverticula MCQ)
      • Pharyngoesophageal and epiphrenic diverticula
      • they are caused by increased esophageal pressure
      • they are false diverticula. MCQ)
    • Traction diverticula
      • Midesophageal diverticula MCQ)
      • and are true diverticula. (MCQ)
    • Signs and symptoms
      • Pharyngoesophageal type is the most likely to be symptomatic
        • Typical symptoms include
          • dysphagia, halitosis (MCQ)
          • regurgitation of food eaten hours to days earlier
          • choking, and aspiration.
      • Midesophageal diverticula are usually asymptomatic. (MCQ)
      • Epiphrenic diverticula may cause (MCQ)
        • dysphagia and regurgitation
        • may be entirely asymptomatic.
    • Diagnosis
      • Barium swallow will reveal the presence of all types of diverticula.
    • Treatment
      • Treatment of Zenker’s diverticulum (MCQ)
        • recommended to relieve symptoms and to prevent complications such as aspiration pneumonia or esophageal perforation.
        • The most common procedure is a cervical esophagomyotomy with resection of the diverticulum. (MCQ)
      • Midesophageal diverticula
        • resected in the occasional incidence of a fistulous connection between the diverticulum and tracheobronchial tree. (MCQ)
      • Epiphrenic diverticula
        • may be treated via resection and esophagomyotomy via a left thoracotomy approach. (MCQ)

Zenker’s Diverticulum Surgery – Endoscopic Staple Diverticulostomy
Zenker’s diverticulum-UCSF, Lawrence Way MD and Jonathan Carter MD
Zenker’s Diverticulum is a sac at the bottom of the throat. When a person swallows, the muscle at the top of the esophagus is supposed to open, and the food should flow through the esophagus. If it doesn’t open, the food pushes down on that muscle and the pressure causes the wall to stretch and extend into a sac called the diverticulum. When a patient swallows, the food will get stuck in that sac.

Zenker’s Diverticulum usually presents in older people. Patients will complain of difficulty swallowing, food sticking, a gurgling sound and a fullness in the neck. Often, 20 or 30 minutes after attempting to swallow, they’ll cough out the undigested food.
Endoscopic Zenker’s Diverticulum repair
Video of surgical repair of a Zenker’s Diverticulum
Zenker’s diverticulum Barium Swallow
A patient’s barium swallow study for a Zenker’s diverticulum
Zenker’s Diverticulum: Endoscopic Septotomy
Zenker’s Diverticulum Endoscopic Repair with Stapler
Zenker’s Diverticulum, edoscopic stapler
LigaSureā„¢ for Endoscopic mucomyotomy of Zenker’s diverticulum