Killian-Jamieson Diverticulum - Irvine, Orange, Newport Beach, Tustin, Los Angeles, Santa Ana, Long Beach, San Diego, Huntington Beach, Riverside, San Bernandino

Difficulty swallowing is a common complaint.  When food sticks in the lower throat, coughing or choking occurs with meals, and there are symptoms of regurgitation of food matter after meals, the diagnosis of a pharyngeal or esophageal diverticulum should be considered.  If you experience these symptoms, you should seek the care of an otolaryngologist or a gastroenterologist, and a barium esophagram should be obtained.  This consists of swallowing contrast material, which outlines the contour of the swallowing tube. 

The most common type of pharyngeal diverticulum is the Zenker's diverticulum, which occurs in the lower throat starting just above the upper esophageal sphincter.  A less common type is the Killian-Jamieson diverticulum, taking off just below the upper esophageal sphincter.  These are less commonly symptomatic, but can also present with the same symptoms as a Zenker's diverticulum.

Treatment consists of surgery if the pouch is symptomatic.  Minimally invasive surgery is preferred, including endoscopic procedures.  In some cases (smaller pouches, restricted mouth opening or neck extension) surgery through the neck is preferable. 

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.