Zenker's Diverticulum

Zenker's diverticulum is an abnormality in the upper gastrointestinal tract. It is a bag-like pouch that occurs in the rear wall of the pharynx. It may cause clinical symptoms and it may become a life-threatening complication during endoscopic examination.

Causes

The rear wall of the pharynx is not completely rigid and locally increased pressure when swallowing can cause its protrusion in some people. The situation tends to occur in the elderly.

Symptoms

Zenker's diverticulum manifests with swallowing disorders. Food falls into the diverticulum, accumulates and sometimes it even returns to the oral cavity. The decomposing food in the pouch of Zenker's diverticulum causes bad breath. In some cases, the condition may be accompanied with sore throat, but this is not the rule. When food suddenly falls out of the diverticulum, it may be aspirated, causing cough and increasing the risk of subsequent pneumonia.

 

Zenker's diverticulum

 

Diagnosis

The diagnosis is a bit difficult. Upper GI endoscopy would be the ideal method, but there is a significant risk that the endoscopic device may be inserted into the pouch and perforate it. Esophageal perforation causes life-threatening infection of thoracic cavity. Therefore, it is advisable to examine a patient with upper swallowing disorder rather by barium swallow. The patient drinks a contrast medium and we see its way through the pharynx and esophagus with local anatomical shape of the upper digestive tract. Zenker's diverticulum filled with contrast looks like a pouch bulging from the posterior wall of pharynx.

Treatment

Small and asymptomatic pouches (that may be found incidentally) are often just monitored and not treated. Larger pouches causing difficulties are treated. They may be “closed” with an endoscopic device or surgically removed. However, the surgical intervention requires skilled thoracic surgeons.