Zenker's Diverticulum
Overview
A Zenker's Diverticulum, sometimes referred to as a pharyngeal pouch, is a herniation of esophageal mucosa through the posterior pharyngeal wall between the thyropharyngeus and cricopharyngeus muscles.
History
The Zenker's diverticulum is named after Friedrich Albert von Zenker (1825–1898), a German pathologist who served as the dean of the medical faculty and prorector at the University of Erlangen.[1]
Pathophysiology
Relevant Anatomy
Zenker's diverticulum occurs as a result of a herniation of the esophageal mucosa through Killian's triangle. Killian's triangle is bounded superiorly by the inferior pharyngeal constrictor muscle (specifically the thyropharyngeus muscle) and inferiorly by the cricopharyngeus muscle.
Disease Etiology
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Histology
Histological section of a Zenker's diverticulum will reveal only the luminal mucosal layer and submucosal tissues. The lack of a muscular layer makes this a pseudodiverticulum rather than a true diverticulum.
Diagnosis
Patient History
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Physical Examination
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Laboratory Tests
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Imaging
Fluoroscopy, such as a barium esophagram, is the preferred imaging modality to characterize Zenker's diverticula. Modified barium swallow studies may also be beneficial if the radiology technician widens the view to include the entire cervical esophagus.
Differential Diagnosis
Other diverticula of the pharyngeal and esophageal mucosa should be considered:
Management
Medical Management
There is no medical management that will significantly impact the development or worsening of a Zenker's diverticulum. Medical management would be limited to the treatment of sequelae of the diverticulum, such as aspiration pneumonia.
Surgical Management
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Outcomes
Complications
The main complication associated with a Zenker's Diverticulum is aspiration secondary to reflux of contents of the diverticulum. Patients will also often complain of halitosis.
Prognosis
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References
- ↑ Haubrich, W. S. (2004). Von Zenker of Zenker’s diverticulum1. Gastroenterology, 126(5), 1269.