diverticulum is at approximately the level of the C5-C6 vertebrae.
The Zenker diverticulum is not a true diverticulum as it represents only the mucosal layer and submucosa being pulled through the weakened area in the pharyngeal constrictors just above the level of the cricopharyngeus. There is no muscularis layer as would be seen in a true diverticulum and the absence of a muscular layer of the diverticulum is another reason why barium fails to empty from the pouch during barium swallow.
Diverticulectomy can be performed endoscopically or surgically with excellent outcomes achieved with both approaches.
Zenker's diverticulum is the most common type of hypopharyngeal diverticulum. Where anatomically does it occur?
ReplyDeleteA. Lateral slit separating cricopharyngeus muscle from proximal esophagus
B.Penetration of the inferior thyroid artery into the hypopharynx
C. Midline posteriorly at Killian's dehiscence
D. Junction of the middle and inferior constrictor muscles
correct answer C
Hypopharyngeal diverticula occur at sites of potential weakness of the muscular lining of the hypopharynx through which the mucosa herniates, leading to a false diverticulum.
A 70-year-old woman presents to your office with symptoms of vomiting undigested food and halitosis. These symptoms have persisted for months. A barium swallow provides the likely diagnosis. She is otherwise healthy and takes only a multivitamin daily. You are confident in your diagnosis and discuss treatment options with the patient. Which of the following treatment options do you recommend?
ReplyDeleteA. Begin calcium channel blocker medication.
B. Eat pureed foods only.
C. Transcervical myotomy with diverticulectomy
D. Diverticulectomy
E. Dilation
This patient likely has Zenker's diverticulum. She is a good surgical candidate. The best treatment option according to current studies is transcervical myotomy with diverticulectomy. Good results are reported 80% to 100% of the time. Diverticulectomy alone carries a risk of recurrence. Calcium channel blockers, dilation, and a pureed diet will not change symptoms and are not treatment options for diverticula. In referral centers with trained endoscopists, there are reports of treatment options via either rigid or flexible endoscopy. The septum between the lumen of the diverticulum and the esophagus is divided with a monopolar argon plasma coagulator or needle-knife.