Thursday, October 28, 2010

Zenker's Diverticulum

A Zenker's diverticulum is an acquired pouch in the lower throat, forming just above the opening to the esophagus. The pouch forms at the site of an anatomic weakness, and is associated with failed relaxation of the upper esophageal sphincter. This can be attributed to acid reflux or neurologic dysfunction.

Zenker's diverticuli have varied presentations, but typically cause difficulty swallowing, regurgitation of food and liquids, and cough. Pills and solid foods become more difficult to swallow, and bad breath (halitosis) is common.

Diagnosis can be made a number of different ways. Physical examination of the neck may reveal a compressable mass in very large diverticuli, which makes a gurgling noise with compression. Laryngoscopy often reveals pooling of mucus in the lower throat, and regurgitation can often be observed. Barium esophagram is most commonly used to make the diagnosis and assess the size of the diverticulum. Other modalities such as CT and MRI are less commonly used but will also confirm the presence of a diverticulum

Treatment is based on symptoms and the size of the diverticulum. For pouches less than 1 cm in size options include observation, cricopharyngeal myotomy (surgically relaxing the upper esophageal sphincter), or Botox injection into the upper esophageal sphincter. For larger diverticuli surgical diverticulostomy or diverticulectomy is indicated. Minimally invasive approaches using a stapler, laser, or Harmonic scalpel can be performed safely and with little morbidity. Open surgical approaches are also an option, and are favored for very large diverticuli.

There is a less than 1% chance of cancer within the Zenker's pouch, and the pouch should be carefully inspected during surgery to rule out a neoplasm.

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