Zenker's diverticulum

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Zenker's diverticulum
Synonyms	Pharyngoesophageal diverticulum
Pronounce	N/A
Specialty	N/A
Symptoms	Dysphagia, regurgitation, cough, halitosis
Complications	Aspiration pneumonia, malnutrition
Onset	Typically in older adults
Duration	Long-term
Types	N/A
Causes	Weakness in the muscle of the esophagus
Risks	Age, sex (more common in males)
Diagnosis	Barium swallow, endoscopy
Differential diagnosis	Esophageal cancer, achalasia, gastroesophageal reflux disease
Prevention	N/A
Treatment	Surgery, endoscopic procedures
Medication	None specific
Prognosis	Generally good with treatment
Frequency	Rare
Deaths	N/A

Zenker's diverticulum is a medical condition characterized by an outpouching or herniation of the mucosal and submucosal layers of the esophageal wall. It occurs specifically at an anatomical location known as Killian's triangle, which is an area of potential weakness where the pharynx and esophagus meet. This condition is named after Friedrich Albert von Zenker, the German pathologist who first described it in the 19th century.

Anatomy and Pathophysiology

Zenker's diverticulum occurs just above the cricopharyngeal muscle, which is part of the Upper esophageal sphincter. The condition is thought to result from increased intraluminal pressure against a weakened esophageal wall.

Killian's Triangle

Killian's Triangle is the anatomic area between the inferior pharyngeal constrictor and the cricopharyngeus muscle where Zenker's diverticulum typically develops.

An anatomical illustration highlighting Killian's Triangle.

Clinical Presentation

Patients with Zenker's diverticulum may present with a range of symptoms, including dysphagia (difficulty swallowing), regurgitation of undigested food, coughing, especially at night, and bad breath (halitosis).

Dysphagia

Dysphagia is often the primary symptom and can progress from difficulty swallowing solids to liquids as the diverticulum enlarges.

Diagnosis

The diagnosis of Zenker's diverticulum often involves a combination of patient history, physical examination, and imaging studies.

Barium Swallow

A Barium swallow X-ray study is the classic diagnostic tool, revealing the presence of a diverticulum as a contrast-filled pouch.

Barium swallow X-ray showing a Zenker's diverticulum.

Endoscopy

Esophageal Endoscopy must be performed with care to avoid perforation but can visualize the diverticulum directly.

Treatment

Treatment options for Zenker's diverticulum can be divided into surgical and non-surgical approaches.

Surgical Approach

Surgical treatment, traditionally the definitive treatment, may involve a cricopharyngeal myotomy and excision or suspension of the diverticulum.

Non-Surgical Approach

Endoscopic techniques have become more common and can involve endoscopic stapling or laser-assisted diverticulotomy.

Complications

If untreated, Zenker's diverticulum can lead to significant morbidity, including aspiration pneumonia, weight loss, and malnutrition.

Epidemiology

Zenker's diverticulum is more common in the elderly population and has a slight male predominance.

See Also

• Esophageal diverticulum
• Dysphagia
• Gastroenterology
• Otorhinolaryngology

External Links

• American Society for Gastrointestinal Endoscopy - Understanding Zenker's Diverticulum
• American Academy of Otolaryngology-Head and Neck Surgery - Zenker's Diverticulum

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