Data were analyzed by t test for independent samples using statistica 12. Endoscopic laser is a nonsurgical treatment method for zenkers diverticulum. Radiographic findings and complications after surgical or. This is a classical esophageal swallow imaging of zenkers diverticulum. Chiropractic center of annapolis annapolis, maryland 410 2665054. Zenkers diverticulum is a pulsion diverticulum that occurs between the lowermost fibers of the inferior pharyngeal constrictor and the cricopharyngeal cp segment. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenkers diverticulum is particularly amenable to surgical correction. It is a pseudo diverticulum not involving all layers of the esophageal wall. Zenkers diverticulum is an outpouching of the pharyngoesophageal mucosa in the natural zone of weakness of the posterior hypopharyngeal wall killians triangle, between the inferior pharyngeal constrictor muscle and the cricopharyngeus muscle upper esophageal sphincter.
Zd is actually a pseudodiverticulum since the zenkers pouch contains only esophageal mucosa and submucosa. Breakthrough in endoscopic treatment of zenkers diverticulum. Per oral endoscopic myotomy for zenker diverticulum penn. Although its precise etiology is uncertain, it is a pulsion type of diverticulum and is thought to arise from increased intraluminal pressure that is caused by incoordination of the the. Zenkers diverticulum is a rare condition, but it is the most common diverticulum in the upper gastrointestinal tract. Endoscopic versus external treatment of zenkers diverticulum. Is a swelling or pulsion that forms at the back of the throat at the junction of the pharynx and esophagus in older.
An esophageal diverticulum is an outpouching that develops in a weakened area of the esophagus. Zenkers diverticulectomy open approach iowa head and. The contents of this web site are for information purposes only, and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Zenkers diverticulum 1 of 4 this middleaged woman has had a known zenkers diverticulum for several years. Malfunctioning of the cricopharyngeal muscle with aging seems to be the main cause. Surgery for zenkers diverticulum involves cutting the cricopharygues muscle.
Otolaryngologyhead and neck surgery, university of texas health science center san antonio, san antonio, tx 78229, usa. This signs and symptoms information for zenkers diverticulum has been gathered from various sources, may not be fully accurate, and may not be the full list of zenkers diverticulum signs or zenkers diverticulum symptoms. While sonography is not the imaging modality of choice for diagnosis of a suspected diverticulum, it is not uncommon to detect during a. Both are performed under general anesthesia with the patient asleep. Article in journal of clinical gastroenterology 393 march 2005 with reads how we measure reads. Has anyone experienced zenkers diverticulum lauri 3 years ago. Zenker diverticulum zd is a pulsion diverticulum that occurs in a natural weakness. A small zenkers diverticulum can be asymptomatic exhibit no symptoms. Zenkers diverticulumendoscopic staple diverticulostomy esd. Meckel diverticulum represents a true diverticulum of the ileum containing all 3 layers of the bowel wall. Sixteen patients who underwent various procedures for repair of zenkers diverticulum diverticulectomy and cricopharyngeal myotomy in n 8, diverticulopexy and cricopharyngeal myotomy n 4, endoscopic stapling diverticulotomy n 3, and cricopharyngeal myotomy alone n 1 had radiographic studies with watersoluble contrast material. Some old food particles and debris and thick mucus were suctioned out of the diverticulum. The series that follows explains some of the reason for her frustration.
It is a pouch that forms in your pharynx, an area just above your esophagus or swallowing tube. Zenkers diverticulumcausessymptomstreatmentdiagnosis. Zenkers diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle. Zenkers diverticulum uc davis center for voice and. This is the first reported case to use any form of crosssectional imaging to aid in diagnosis and assessment.
The condition goes by several names, depending on the location of the pouch. She has now reached a point of frustration that has motivated her to proceed with cricopharyngeus myotomy. Endoscopically stapled diverticulostomy for zenkers diverticulum. Zenkers diverticulum zd or pharyngeal pouch is a rare esophageal disorder with an annual incidence of just 2 per 100,000. If that was unsuccessful he would go to plan b which involved an incision in my lower neck region. Meckels diverticulum was named after johann friedrich meckel, who described its anatomy and embryology in 1809. These may be asymptomatic until they become inflamed.
Meckels diverticulum is a remnant of the omphalomesenteric or vitelline duct, which connects the yolk sac to the midgut through the umbilical cord. Click here to jump down to questions about treatment zenkers diverticulum is a pouch that forms at the back of the throat at the junction of the pharynx and the esophagus the food passage to the stomach. Zenkers diverticulum zd or pharyngeal pouch is a rare esophageal. This pouch typically causes problems by trapping food as it is being swallowed, leading to choking and aspiration. Fibreoptic diverticular repair is another of the methods for treating zenkers diverticulum. In the image to the right, the arrow is pointing to the. After being placed under general anesthesia, a special bivalved laryngoscope is placed into your mouth and advanced to where the diverticulum is located. May occur with dysphasia or foulsmelling breath in old people. Depending upon which layers of the structure are involved, diverticula are described as being either true or false. 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.
Wasserzug o, zikk d, raziel a, cavel o, fleece d, szold a. We aim to become the reddit home of radiologists, radiographers, technologists, sonographers and layusers interested in medical imaging. This happens when there is pressure on your pharynx and it balloons out. Meckel diverticulum develops if the omphalomesenteric vitellointestinal or vitelline duct, which connects the primitive midgut with the yolk sac, fails to obliterate, which normally occurs at 78 weeks of gestation. 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. Endoscopically stapled diverticulostomy for zenker s diverticulum. 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.
It is the most common type of esophageal 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. Less common locations are midesophageal and supradiaphragmatic 1. A zenkers diverticulum is an esophageal pouch that develops in the upper esophagus which causes difficulty swallowing and regurgitation of food. Zd is actually a pseudodiverticulum since the zenker s pouch contains only esophageal mucosa and submucosa. Zenkers diverticulum symptoms, diagnosis, treatments and. In this disorder, a large pouch called a diverticulum develops in a weak area between the pharynx throat and upper esophagus the food tube that reaches from the throat to the stomach. The stapler was positioned with one limb in the esophagus and the other in the diverticulum. Pdf nursing approach to zenkers diverticulum surgery. Although the incidence of zenkers diverticulum zd in the general population is low 0. More detailed information about the symptoms, causes, and treatments of zenkers diverticulum is available below symptoms of.
All the volunteers showed lateral laryngopharyngeal diverticula 3. There are two approaches to treatment of the condition. Zenker diverticulum definition of zenker diverticulum by. Zenker diverticulum, also known as a pharyngeal pouch, is a posterior outpouching of the hypopharynx, just proximal to the upper esophageal sphincter through. Publications home of jama and the specialty journals of. Copd360social posts are monitored by senior director of community engagement and copd360social community manager. Heterotopic tissue, including gastric mucosa and pancreatic tissue, is. Zenker diverticulum experience in surgical treatment of large diverticula. Principles of surgical treatment of zenker diverticulum.
To consider how zenker diverticulum arises, its important you understand the swallowing process. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenkers diverticulum sac. Zenker s diverticulum is a defect in the muscular wall of the hypopharynx in an area known as killians triangle. Endoscopic treatment for zenkers diverticulum is safe.
Zenkers diverticula are usually located in the back of the throat, just above the. Is an endoscopic or external diverticulectomy more effective for treatment of zenkers diverticulum. 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. These diverticula are uncommon and tend to occur in elderly people. This procedure is done under a general anesthesia at the hospital. This duct is typically obliterated by the 5th8th week of gestation. Slide 4 and slide 4b special sutures are placed to anchor the common wall between the diverticulum and esophagus swallowing tube. The most common form, zenkers diverticulum is found at the level of the lower neck and usually at the back of the throat. When incidentally imaged on computed tomography ct scans, a zenker diverticulum appears as a structure arising posteriorly from the. Some neurologic diseases, such as a stroke, may result in malfunctioning of the cricopharyngeal muscle.
Zenkers diverticulum is a sac or pouch at the back of the throat which causes difficulty swallowing. Zenker diverticulum is the most common proof of a primitive pharyngoesophageal motility disorder. Dysphagia characteristics in zenker s diverticulum. The pharyngeal pouch zenkers diverticulum is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle i. In medicine, the term usually implies the structure is not normally present. This segment is the upper esophageal sphincter ues and is composed of the cricopharyngeus muscle and a portion of the upper esophagus musculature figure 11. A zenkers diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle i.
A zenkers diverticulum zd is a blind sac pouch that branches off the cervical esophagus. Large zenker diverticula with the septum longer than 6 cm should preferably be resected through. Zenkers diverticulectomy southern california, orange. Zenker diverticulum zd is an acquired anatomic defect that manifests as herniation of the mucosa and. 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. It is a pulsion diverticulum that is likely the result of poor coordination between the pharyngeal and upper esophageal sphincter. Furthermore, signs and symptoms of zenkers diverticulum may vary on an individual basis for each patient. There are two common surgeries performed for treatment of zenkers diverticulum. Zenker s diverticulum is a rare condition in which a pouch forms at the junction of the pharynx and the esophagus. Zenkers diverticulum repair what is zenkers diverticulum. It always occurs above and never below the cricopharyngeus muscle. While imaging is the mainstay of diagnosing zd, the utility of history, physical examination, and office procedures routinely performed by otolaryngologists, such as fees and. A zenkers diverticulum is a pouch located in the back of the throat that causes difficulty swallowing. Zenkers diverticulum is a rare condition that makes it difficult to swallow food and liquids.
212 1244 811 1432 386 522 826 1273 1643 859 458 1526 476 928 979 374 1148 1327 584 1350 1482 1515 706 23 1058 782 218 257 1179 670 556 246 118 435 486 343 918 1384 886 831 1433 282 1157 41 757 1455 477 472 81 1205