Zenkers diverticulum a sac or pouch in the back of the throat which causes difficulty swallowing by collecting and retaining food and saliva. All patients with zenkers diverticulum will swallow better following treatment of the. Ferguson, md section of thoracic surgery, department surgery, the university of chicago medical center, chicago, illinois the early publications of zenker and later reports by clagett and payne highlight our understanding of the. Zenkers diverticulum and other esophageal diverticula. Simultaneous bronchoscopy and esophagoscopy revealed thick mucoid secretions and a fistula emanating from the esophageal diverticulum. They can occur at different levels of the esophagus. Outpouching of alimentary tract containing all visceral layers emedicine. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenker s diverticulum sac. Traditionally, esophageal diverticula are classified as either traction diverticula, occurring primarily in the. Zenkers diverticulum ent services in arizona valley ent. Report a case of huge zenkers diverticulum with date. Evolution of therapy for pharyngoesophageal zenkers. Zenkers diverticulum zd pharangeal diverticulum may be posterior, lateral or posterolateral, but the most commonly encountered type is the posterior pulsion diverticulum. Zenkers diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass.
We offer a minimallyinvasive treatment option using endoscopic transpharyngeal cricopharngeal mytomy for symptomatic patients with zenkers diverticulm. Zenkers diverticulumendoscopic staple diverticulostomy esd. Zenkers diverticulum zd or pharyngeal pouch is a rare esophageal disorder with an annual incidence of just 2 per 100,000. These steps also prevent patients who are not surgical candidates from wasting their time.
Usually found in pairs on opposite sides of the bladder. Zenker diverticulum, also known as a pharyngeal pouch, is a posterior outpouching of the hypopharynx, just proximal to the upper esophageal sphincter through a weakness in the muscle layer called the killian dehiscence. Pdf nursing approach to zenkers diverticulum surgery. The diverticulum is resected, and myotomy of the cricopharyngeal muscle is performed to avoid recurrence. Umar handdrawn videos zenkers diverticulum please visit my website facebook page please like and. Zenkers diverticulum and cp dysfunction fact and fiction joshua s. Zenkers diverticulum is a rare condition that causes a pouch to form in the lower walls of the throat. Zenkers diverticulum the annals of thoracic surgery. Although zenkers diverticulum is the most common type of esophageal diverticulum, the true incidence is difficult to determine because so many people with the disorder. Zenkers diverticulum repair what is zenkers diverticulum. University of virginia health system, department of otolaryngologyhead and neck surgery, charlottesville, virginia, usa. What i dont understand is if i tilt my head a little to the right, all the saliva gunk falls to the right side of my throat and wakes me up coughing. Zenkers diverticulum zd, also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and. May 25, 2017 zenker s diverticulum is a benign, rare condition that can affect your quality of life significantly because it decreases your swallowing ability of food and liquids.
The most common form, zenkers diverticulum is found at the level of the lower neck and usually at the back of the throat. Zenkers diverticulum is a pseudodiverticulum of the esophagus that forms in. It is the most common type of oesophageal diverticula with a reported prevalence ranging between 0. Endoscopically stapled diverticulostomy for zenkers diverticulum. A videoesophagram is the most effective way to diagnose a zenker s diverticulum. Is a swelling or pulsion that forms at the back of the throat at the junction of the pharynx and esophagus in older. This pouch typically causes problems by trapping food as it is being swallowed, leading to dysphagia difficulty swallowing, regurgitation of. A new study reports that flexible endoscopic treatment of zenker s diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. The condition can lead to problems with swallowing and cause coughing, choking, and bad breath. A zenkers diverticulum is the rarest type of gastrointestinal diverticulum and is located immediately above the upper esophageal sphincter and typically presents in the elderly population with dysphagia regurgitation, halitosis, and malnutrition. Publications home of jama and the specialty journals of. More precisely, while traction and pulsion mechanisms have long been deemed the main. Endoscopic pharyngoesophageal zenkers diverticulostomy. There are two types of esophageal diverticulapulsion and traction.
The procedure is performed entirely through the mouth. Zenkers diverticulum is an acquired saclike outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through killians dehiscence. Esophageal diverticula also may be found in the midesophageal area near the pulmonary hilum and in the epiphrenic region in the. Traction diverticula and epiphrenic diverticula usually require no treatment. Zenker s diverticulum zd is a saclike outpouching of the mucosa and submucosa through killian s triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle. This presentation was done at the mm meeting to discuss techniques and management of a zenkers diverticulum. Dec 01, 2012 zenker s diverticulum is an acquired saclike outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through killian s dehiscence.
More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a zenkers diverticulum, current consensus considers occlusive mechanisms to be most important. Review of literature and experience in 159 consecutive cases. Balloonlike growths on the bladder commonly associated with a chronic outflow obstruction, such as benign prostatic hyperplasia in older males. Endoscopic treatment for zenkers diverticulum is safe long.
Occasionally a diverticulum is used in a more general sense to mean the outpouching of other anatomical structures, e. Diagnostic testing o laboratory evaluation little or no value o diagnostic imaging barium swallow study of choice posterior midline pouch 2 cm diameter arising just above cricopharyngeus muscle. Umar handdrawn videos zenker s diverticulum please visit my website facebook page please like and. Classics in thoracic surgery evolution of therapy for pharyngoesophageal zenkers diverticulum mark k. 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. Zenker s diverticulum zd results from posterior herniation of esophageal mucosa into killian s triangle, an area of least resistance situated above the cricopharyngeus cp muscle and below the inferior pharyngeal constrictor muscle. The combination of obstruction, pressure and bulging, repeated over thousands of swallows, eventually leads to a permanent bulge or pouch called a zenker s diverticulum. Pdf nursing approach to zenkers diverticulum surgery patient. Postoperative instructions following arizona sinus.
Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenker s diverticulum is particularly amenable to surgical correction. If i do, i have it on both sides of my throat with the left side being much worse than the right side. Zenkers diverticulectomy southern california, orange. It is a pseudo diverticulum not involving all layers of the esophageal wall. Diverticulum is the singular form and diverticula is the correct latin plural form. Todd baron defines zenkers diverticulum and its symptoms. Zenkers diverticulum is a benign, rare condition that can affect your quality of life significantly because it decreases your swallowing ability of food and liquids. Zenkers diverticulum is a condition characterized by a pouch that can form at the junction of the hypopharynx lower part of the throat and the esophagus. Zenker diverticulum zd is a specific type of esophageal diverticulum that results in herniation of esophageal mucosa from an area of muscular weakness, also known as killian dehiscence, located between the inferior aspect of the inferior constrictor muscle and the cricopharyngeus cp muscle and is a common problem facing the head and neck surgeon. There are two common surgeries performed for treatment of zenker s diverticulum. Zenker s diverticulum is the most recognizable diverticulum of the esophagus. Zenkers diverticulum an overview sciencedirect topics.
Barium esophagogram of a zenker s diverticulopexy a difficult passage through the upper esophageal sphincter should alert the examiner to the possibility of a hypertonic sphincter or a zenker s diverticulum. A barium esophagram confirmed a bronchoesophageal fistula figures 2 and 3. Zd is actually a pseudodiverticulum since the zenker s pouch contains only esophageal mucosa and submucosa. Zenker diverticulum is the most common proof of a primitive pharyngoesophageal motility disorder. Endoscopically stapled diverticulostomy for zenker s diverticulum.
Zenkers diverticulum definition of zenkers diverticulum. With this condition, you acquire a large sac below your cricopharynx in the upper part of your esophagus due to cricopharyngeal muscle spasms contractions causing a lumpinthe. Though you dont have to live in another state, if you live at least 2 hours drive away and would like to travel to warrenton, va to have dr. It represents 70% of all cases of diverticula, followed by traction diverticula 20% and epiphrenic diverticula 10%. Both are performed under general anesthesia with the patient asleep. Zenkers degeneration medical definition merriamwebster. Jun 18, 2014 endoscopic management of zenker s diverticulum. Endoscopic treatment for zenkers diverticulum is safe. A zenkers diverticulum, more formally known as a hypopharyngeal diverticulum, is a pouch that can form at the junction of the hypopharynx lower part of the throat and the esophagus, an area known as killians triangle. Esophageal diverticula traction diffuse idiopathic skeletal hypertrophy. Publications home of jama and the specialty journals of the. Wasserzug o, zikk d, raziel a, cavel o, fleece d, szold a.
A videoesophagram is the most effective way to diagnose a zenkers diverticulum. The operation can be performed endoscopically or openly. Zenkers diverticulectomy open approach iowa head and. Although the cause of zenkers diverticulum is unknown, it can be corrected with traditional surgery or advanced procedures that do not even require an incision. Data of 34 patients with zenker s diverticulum, treated by endoscopic carbon dioxide laser diverticulotomy at the department of. Given the lack of incisions, patients are allowed to start eatingdrinking the day after surgery. Zenker s diverticulum zd is a saclike outpouching of the mucosa and submucosa through killians triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle. Zenkers diverticulum southern california, orange county. It is an outpouching that develops in a weakened area at the back of the throat.
Zenker s diverticulum is an acquired saclike outpouching of the mucosa and submucosa layers located dorsally at the pharyngoesophageal junction through killian s dehiscence. Zenkers diverticulum smelly breath ruining your day duration. Copd360social posts are monitored by senior director of community engagement and copd360social community manager. The condition appears more often in people over 50, and. Transoral resection of short segment zenkers diverticulum.
Like traction diverticula, they contain all the layers of the esophageal wall. Why would a zenker s diverticulum recur after surgical treatment. Zenker s diverticulum is a rare, benign throat disorder seen mainly in elderly people. This happens when there is pressure on your pharynx and it balloons out. Baron also discusses traditional surgical management, as well as. Comparing different surgical approaches for zenkers diverticulum. Chang treat your zenker s diverticulum using the mininimally invasive esd procedure, here are the steps to take. Zenker s diverticulum is a pseudodiverticulum of the esophagus that forms in the killian s triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. Mortality rates are very low, and the success rate is high 95%. This procedure is done under a general anesthesia at the hospital. The condition goes by several names, depending on the location of the pouch. A zenkers diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human. Zenker s diverticulum is generally categorized as small, intermediate, or large, depending on the size of the pouch.
There is a common wall that separates the esophagus from the diverticulum pouch. A new study reports that flexible endoscopic treatment of zenkers diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. Symptoms are typically a feeling of a lump in the throat or it feels like food gets stuck. It was later reclassified by and has since been eponymously linked with zenker. Zenkers diverticulum is a rare condition, but it is the most common diverticulum in the upper gastrointestinal tract. Surgery for zenker s diverticulum involves cutting the cricopharygues muscle. Zenker s diverticulum zd results from posterior herniation of esophageal mucosa into killians triangle, an area of least resistance situated above the cricopharyngeus cp muscle and below the inferior pharyngeal constrictor muscle.
All 3 constrictors pass around and insert into a midline raphe on the posterior pharynx and vary in where they originate. It is a pouch that forms in your pharynx, an area just above your esophagus or swallowing tube. Principles of surgical treatment of zenker diverticulum. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenkers diverticulum is particularly amenable to surgical correction. Posterior pulsion diverticulum at the cricopharyngeus was first described by ludlow in 1769. This raphe suspends the pharynx from the base of skull at the pharyngeal tubercle, which is a palpable bump. With zenkers diverticula, however, there is always a surgical indication. The barium used in the procedure fills the pouch, making it visible in the upper part of the esophagus, as shown in the picture below. A zenker s diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle i.
However, the first observation was made by abraham ludlow in 1679. Zenkers diverticulum is a pseudodiverticulum of the esophagus that forms in the killians triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. We were able to place an allis on the distal aspect of the diverticulum, and with lateral traction, a 45 mm x 3. Traction diverticulum of the esophagus esophagus traction. Symptoms of zenkers diverticulum including 8 medical symptoms and signs of zenkers diverticulum, alternative diagnoses, misdiagnosis, and correct diagnosis for zenkers diverticulum signs or zenkers diverticulum symptoms. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenkers diverticulum sac. Zenkers diverticulum are found at the base of the neck and may be related to spasm of the adjacent muscle sphincter cricopharnygeus. Zenker diverticulum an overview sciencedirect topics. We report our experience with this procedure and try to sum up recent recommendations for management of surgery and postoperative care. Although zenker s diverticulum is the most common type of esophageal diverticulum, the true incidence is difficult to determine because so many people with the disorder. Has anyone experienced zenkers diverticulum lauri 3 years ago. Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa through killians triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle. Zenkers diverticulum medical definition merriamwebster. Nov 16, 2011 video of surgical repair of a zenker s diverticulum.
A zenker s diverticulum is a pouch located in the back of the throat that causes difficulty swallowing. Esophageal diverticula are uncommon lesions that are usually classified according to their location cervical, thoracic, or epiphrenic. The etiology of zenker s diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. Endoscopic pharyngoesophageal diverticulostomy is performed to address an abnormal pouch diverticulum that originates above a constriction at the entrance to the esophagus. Zenker s diverticulum is a pseudodiverticulum of the esophagus that forms in the killians triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle.
Nowadays endoscopic diverticulotomy is the surgical approach of the first choice in treatment of zenker s diverticulum. A straight scope is used to evacuate any material in the pocket and make sure the pocket is large enough to divide the common wall between it and the esophagus, or swallowing tube. This book is distributed under the terms of the creative commons. An esophageal diverticulum is an outpouching that develops in a weakened area of the esophagus. The etiology of zenkers diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. Zenker diverticulum accessed 14 february 2019 may cause obstruction, aspiration pneumonia, abscess, infection, hemorrhage or be associated with malignancy. The early publications of zenker and later reports by. A subsequent ct scan of the chest suggested an esophageal traction diverticulum and erosion into the apical segment of right upper lobe.
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