Zenker's diverticulum
Encyclopedia
In anatomy
, Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, is a diverticulum
of the mucosa of the pharynx
, just above the cricopharyngeal muscle (i.e. above the upper sphincter
of the esophagus
). It is a false diverticulum (not involving all layers of the esophageal wall).
It was named in 1877 by German
pathologist Friedrich Albert von Zenker
.
, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum
which may reach several centimetres in diameter.
More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (variously known as Killian's triangle, Laimer's triangle, and the Killian-Laimer triangle). The result is an outpouching of the posterior pharyngeal wall, just above the oesophagus, specifically just above the cricopharyngeal muscle.
While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as dysphagia
(difficulty swallowing), and sense of a lump in the neck; moreover, it may fill up with food, causing regurgitation
(reappearance of ingested food in the mouth), cough
(as some food may be regurgitated into the airways), halitosis
(smelly breath, as stagnant food is digested by microrganisms), potential infection of the pharyngeal areas due to food stuck, and involuntary gurgling noises when swallowing. It rarely, if ever, causes any pain.
Cervical webs are seen associated in 50% patients with this condition.
will normally reveal the diverticulum
. Endoscopy
should not be performed due to the risk of perforating the diverticulum.
to resect the diverticulum
and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling (i.e. closing off the diverticulum via a stapler inserted through a tube in the mouth). This may be performed through a fibreoptic endoscope.
Other non-surgical treatment modalities exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
, Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, is a diverticulum
Diverticulum
A diverticulum is medical or biological term for an outpouching of a hollow structure in the body. Depending upon which layers of the structure are involved, they are described as being either true or false....
of the mucosa of the pharynx
Pharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
, just above the cricopharyngeal muscle (i.e. above the upper sphincter
Sphincter
A sphincter is an anatomical structure, or a circular muscle, that normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning...
of the esophagus
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
). It is a false diverticulum (not involving all layers of the esophageal wall).
It was named in 1877 by German
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
pathologist Friedrich Albert von Zenker
Friedrich Albert von Zenker
Friedrich Albert von Zenker was a German pathologist and physician, celebrated for his discovery of trichinosis. He was born in Dresden, and was educated in Leipzig and Heidelberg. Attached to the city hospital of Dresden in 1851, he added, in 1855, the duties of professor of pathological...
.
Mechanisms and manifestations
In simple words, when there is excessive pressure within the lower pharynxPharynx
The human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum
Diverticulum
A diverticulum is medical or biological term for an outpouching of a hollow structure in the body. Depending upon which layers of the structure are involved, they are described as being either true or false....
which may reach several centimetres in diameter.
More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (variously known as Killian's triangle, Laimer's triangle, and the Killian-Laimer triangle). The result is an outpouching of the posterior pharyngeal wall, just above the oesophagus, specifically just above the cricopharyngeal muscle.
While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as dysphagia
Dysphagia
Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right. Sufferers are sometimes unaware of their dysphagia....
(difficulty swallowing), and sense of a lump in the neck; moreover, it may fill up with food, causing regurgitation
Regurgitation (digestion)
Regurgitation is the expulsion of material from the mouth, pharynx, or esophagus, usually characterized by the presence of undigested food or blood.Regurgitation is used by a number of species to feed their young...
(reappearance of ingested food in the mouth), cough
Cough
A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
(as some food may be regurgitated into the airways), halitosis
Halitosis
Halitosis is a term used to describe noticeably unpleasant odors exhaled in breathing. Halitosis is estimated to be the third most frequent reason for seeking dental aid, following tooth decay and periodontal disease.- General :...
(smelly breath, as stagnant food is digested by microrganisms), potential infection of the pharyngeal areas due to food stuck, and involuntary gurgling noises when swallowing. It rarely, if ever, causes any pain.
Cervical webs are seen associated in 50% patients with this condition.
Diagnosis
A simple barium swallowBarium swallow
A barium swallow is a medical imaging procedure used to examine the upper GI tract, which includes the esophagus and, to a lesser extent, the stomach.-Principle:...
will normally reveal the diverticulum
Diverticulum
A diverticulum is medical or biological term for an outpouching of a hollow structure in the body. Depending upon which layers of the structure are involved, they are described as being either true or false....
. Endoscopy
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
should not be performed due to the risk of perforating the diverticulum.
Treatment
If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
to resect the diverticulum
Diverticulum
A diverticulum is medical or biological term for an outpouching of a hollow structure in the body. Depending upon which layers of the structure are involved, they are described as being either true or false....
and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling (i.e. closing off the diverticulum via a stapler inserted through a tube in the mouth). This may be performed through a fibreoptic endoscope.
Other non-surgical treatment modalities exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.