Because the bottom of the pouch is lower than the opening into the throat, secretions and food particles build up in the pouch. The condition goes by several names, depending on the location of the pouch. Koch m, mantsopoulos k, velegrakis s, iro h, zenk j. Dysphagia after endoscopic repair of zenkers diverticulum. Pdf nursing approach to zenkers diverticulum surgery patient. The main cause of zenkers diverticulum is thought to be malfunctioning of the cricopharyngeal muscle due to the aging process. Another patient had total dysphagia of 3 days duration because of food impaction in the zenker s diverticulum along with intense dehydration with hypotension and mental confusion. Strictures, zenkers diverticulum, neoplasms, and dysphagia red flags.
Feb 15, 2008 the effectiveness of myotomy of the cricopharyngeus as the sole treatment of zenkers diverticulum has been demonstrated in multiple studies. Zenkers diverticulum and other esophageal diverticula. Zenker diverticulum diverticula esophago pharyngeal. Zenkers diverticula are more common in men than women and usually present in persons over 60 years of age. These are usually first noted during the 5 th to 7 th decade of life. It often appears in the elderly, usually over 70 years of age. Zenker s diverticulum zd is a saclike outpouching of the mucosa and submucosa through killian s triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle figure 1. After resuscitation a first endoscopic procedure was performed to withdraw the remains of food from the diverticulum and to introduce a nasogastric tube. For submission instructions, please see the gastroenterology web site.
Zenkers diverticulum is a sac at the bottom of the throat. The pathophysiology of zenker s diverticulum, clinical presentation, and. Furthermore, signs and symptoms of zenker s diverticulum may vary on an individual basis for each patient. This signs and symptoms information for zenkers diverticulum has been gathered from various sources, may not be fully accurate, and may not be the full list of zenkers diverticulum signs or zenkers diverticulum symptoms. Difficulty swallowing dysphagia, often with a feeling of a lump in your throat. Zenker s diverticulum is a rare disease, which can cause considerable suffering. Larger, symptomatic cases of zenkers diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. The reappearance of ingested food regurgitation in your mouth when food becomes trapped in the outpouching.
Evaluation and treatment of zenkers diverticulum springerlink. This pocketlike structure can appear anywhere in the esophageal lining between the throat and stomach. The technique of endoscopic treatment of hypopharyngeal diverticula is described. An esophageal diverticulum is a pouch that protrudes outward in a weak portion of the esophageal lining. When this muscle is cut the throat relaxes, making swallowing easier. Over a lifetime of swallowing, when there is excessive pressure within the lower portion of the pharynx the back wall of the throat, the weakest portion of the pharyngeal wall balloons out. Zenker s diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle. Predominant symptoms are dysphagia and regurgitation. Dysphagia difficulty swallowing regurgitation return of undigested food back into the mouth sense of a lump in the neck. The results obtained seem to confirm that endoscopic treatment of a hypopharyngeal diverticulum is to be preferred to an. Zenkers diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle.
The pathophysiology of zenkers diverticulum, clinical presentation, and. Zenkers diverticulum zd results from posterior herniation of esophageal mucosa into killians triangle, an area of least resistance situated above the cricopharyngeus cp muscle and below the inferior pharyngeal constrictor muscle. Show full abstract a zenker s diverticulum in 75 years old sudanese man with a chronic history of dysphagia for solids. Zenkers diverticulum zd is a saclike outpouching of the lining of the esophageal wall at the upper esophagus. Zenker s diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. A new study reports that flexible endoscopic treatment of zenkers diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. It is a pouch that forms in your pharynx, an area just above your esophagus or swallowing tube. More detailed information about the symptoms, causes, and treatments of zenkers diverticulum is available below. Zenker s diverticulum surgery method l cervical incision, vertical myotomy several cm on either side of base of diverticulum, remove or suspend diverticulum, leave drains postop cricopharyngeal myotomy.
Endoscopic treatment of zenkers diverticulum sciencedirect. Zenkers diverticulumendoscopic staple diverticulostomy esd. Upon completion of this activity, participants will be able to. A small zenkers diverticulum can be asymptomatic exhibit no symptoms. New and emerging techniques for endoscopic treatment of zenkers. The results with number and type of complications in 274 endoscopically treated patients including 6 patients with a recurrent diverticulum after transcutaneous surgery are reported. Zenker diverticulum is a term describing the herniation of the mucosal and submucosal layers of the pharynx through the cricopharyngeus muscle at the pharyngoesophageal junction. Endotherapy of zenker s diverticulum using the needleknife technique. When a person swallows, the muscle at the top of the esophagus is supposed to open. Endoscopic treatment for zenkers diverticulum is safe long.
Zenkers diverticulum symptoms, diagnosis, treatments and. Endoscopic stapling technique for the treatment of zenker. Jun 18, 2014 vogelsang a, preiss c, neuhaus h, et al. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Zenkers diverticulum zd, also known as cricopharyngeal, pharyngoesophageal or. Baron also discusses traditional surgical management, as well as. The objective of an excision of zenker s diverticulum is not only to remove the diverticulum, but to release the malfunctioning muscle of the throat the cricopharyngeus cp muscle.
Zenker s diverticulum is a rare, benign throat disorder seen mainly in elderly people. The only treatment to cure zenkers diverticulum is a surgical intervention, which relieves symptoms and improves the quality of life. Dysphagia in a patient with a zenkers diverticulum. It is a pulsion diverticulum that is likely the result of poor coordination between the pharyngeal and upper esophageal sphincter contractions at an area of anatomical weakness. Endoscopic treatment for zenkers diverticulum is safe longterm. Transoral endoscopic excision of zenkers diverticulum.
Larger, symptomatic cases of zenker s diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. All patients with zenkers diverticulum will swallow better following treatment of the zenker s diverticulum. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenkers diverticulum is particularly amenable to surgical correction. Zenkers diverticulum zd is an outpouching of tissue through the killian triangle that is believed to be caused by dysfunction of the cricopharyngeal muscle. A zenkers diverticulum is a pouch that forms at the end of the throat and the beginning of the esophagus the swallowing tube. Pharyngeal zenker s diverticulum is a disorder of upper. Initial treatment is focused on a reduction of immunosuppression. Affected individuals may suffer from longstanding swallowing difficulties dysphagia, regurgitation, bad breath, weight loss, and even aspiration the passage of food or other hazardous material into the lungs. Endotherapy of zenkers diverticulum using the needleknife technique.
Pdf principles of surgical treatment of zenker diverticulum. Zenkers diverticulum is a pseudodiverticulum of the esophagus that forms in the killians triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. Treatment for zenkers diverticulum is aimed in alleviating the presenting symptoms of the client. It has been known that the best option for this condition is to do nothing.
A new treatment for zenkers diverticulumsubmucosal. Flexible endoscopic and surgical management of zenkers. Patients with this condition often exhibit no symptoms. Zenkers diverticulum southern california, orange county. The etiology of zenker s diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. Treatment is recommended for symptomatic patients and considering the aetiopathogenesis of the. Pdf pharyngoesophageal diverticula are most frequently described in elderly patients, having symptoms such as dysphagia, regurgitation, chronic. Zenkers diverticulum tough to swallow cornerstone ear. Zenker s diverticulum is diagnosed using a test called a barium swallow. When a person swallows, the muscle at the top of the esophagus is supposed to open, and the food should flow through the esophagus. The word derives from the greek roots dys, which means difficulty, and phago, which means to eat.
Common symptoms of the disease include difficulties in swallowing dysphagia, food reflux regurgitation, unpleasant breath smells halitosis and couch. Diagnostic testing o laboratory evaluation little or no value. Zenkers diverticulum zd, or pharyngeal pouch, is an anatomical defect. This signs and symptoms information for zenker s diverticulum has been gathered from various sources, may not be fully accurate, and may not be the full list of zenker s diverticulum signs or zenker s diverticulum symptoms. Zenkers diverticulum is a rare disease, which can cause considerable suffering. Endoscopic stapling is the currently preferred treatment for zenkers diverticulum, i. As the pouch enlarges and dysphagia increases, symptoms become more severe with resultant weight loss. Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa through killians triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle figure 1. Zenkers diverticulum and swallowing disorders treatment. The goal of this activity is to evaluate the diagnosis and management of zenkers diverticulum.
A new study reports that flexible endoscopic treatment of zenker s diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenker s diverticulum is particularly amenable to surgical correction. The results obtained seem to confirm that endoscopic treatment of a hypopharyngeal diverticulum is to be preferred to an external. May 25, 2017 the only treatment to cure zenkers diverticulum is a surgical intervention, which relieves symptoms and improves the quality of life. It can be asymptomatic or cause dysphagia and regurgitation.
Therapy of zenkers diverticulum pubmed central pmc. This indicates that the cricopharyngeus plays a central pathophysiological role in giving rise to the condition 1, 3 5 and suggests that the treatment of zenkers diverticulum should always. Furthermore, signs and symptoms of zenkers diverticulum may vary on an individual basis for each patient. Todd baron defines zenker s diverticulum and its symptoms. Assess the clinical presentation of zenkers diverticulum.
Endoscopic treatment of zenkers diverticulum springerlink. The predominant symptom of zd is dysphagia, and the most serious consequence is pulmonary aspiration. Presently, there arent any medications yet that treats the condition and if you leave the condition untreated, youll continue to have trouble swallowing which can cause malnutrition, weight loss or pneumonia. Zenker s diverticulum zd is a saclike outpouching of the lining of the esophageal wall at the upper esophagus. A septum between the diverticulum and the lumen of the esophagus can develop and hamper the passage of food. It is a rare disease typically seen in the middleaged and older adults. Dysphagia, odynophagia, and regurgitation are seen in the. Although zenker s diverticulum is the most common type of esophageal diverticulum, the true incidence is difficult to determine because so many people with the disorder. Zenker diverticulum zd is a specific type of esophageal diverticulum that results in herniation of esophageal mucosa from an area of muscular weakness, also known as killian dehiscence, located between the inferior aspect of the inferior constrictor muscle and the cricopharyngeus cp muscle and is a common problem facing the head and neck surgeon. This happens when there is pressure on your pharynx and it balloons out. Apr 27, 2017 the main cause of zenkers diverticulum is thought to be malfunctioning of the cricopharyngeal muscle due to the aging process.
The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenker s diverticulum sac. Patients with a zenker s diverticulum experience symptoms when food or secretions get stuck in the pouch. Esophageal diverticula gastrointestinal disorders merck manuals. The most common form, zenkers diverticulum is found at the level of the lower neck and usually at the back of the throat. Dysphagia after endoscopic repair of zenkers diverticulum article pdf available in the laryngoscope 1174. A zenkers diverticulum, more formally known as a hypopharyngeal diverticulum, is a pouch that can form at the junction of the hypopharynx lower part of the throat and the esophagus, an area known as killians triangle. When food and saliva fill up the pouch, however, symptoms can occur and may include.
Symptoms of esophageal diverticula dysphagia and regurgitation. A barium swallow is a special xray that highlights the inside of your mouth, pharynx, and esophagus. A condition that progressively worsens over time, esophageal diverticulum most often strikes adults over 60 years of age. Show full abstract a zenkers diverticulum in 75 years old sudanese man with a chronic history of dysphagia for solids. Zenkers diverticulumcausessymptomstreatmentdiagnosis. Zenker s diverticulum is a pseudodiverticulum of the esophagus that forms in the killian s triangle, between the inferior pharyngeal constrictor and the cricopharyngeus cp muscle. May, 2017 zenkers diverticulum is a sac at the bottom of the throat. Introduction dysphagia is the sensation that swallowing is difficult or impossible. Jun 18, 2014 dysphagia characteristics in zenkers diverticulum.
Zd is a relatively uncommon disorder occurring in the elderly. Zenkers diverticulum an overview sciencedirect topics. This shall only warrant for an intervention when it has come to a point of disability to the client. A barium swallow fluoroscopy allows your doctor to see how you swallow in motion. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenkers diverticulum sac.
These diverticula are uncommon and tend to occur in elderly people. Halitosis smelly breath due to stagnant food in the pouch. This pouch typically causes problems by trapping food as it is being swallowed, leading to choking and aspiration. Although zenkers diverticulum is the most common type of esophageal diverticulum, the true incidence is difficult to determine because so many people with the disorder. Apr 30, 20 a new study reports that flexible endoscopic treatment of zenker s diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. Symptoms include dysphagia, regurgitation, halitosis, postprandial vomitus and cough. However, in recent times nonsurgical endoscopic techniques have gained more importance as they allow for much faster recovery, and the currently preferred treatment is endoscopic. It is most likely as a result of increased intraluminal pressure and tissue degeneration.
Zenkers diverticulum a sac or pouch in the back of the throat which causes difficulty swallowing by collecting and retaining food and saliva. Preoperative assessment using fiberoptic endoscopic evaluation of swallowing demonstrated that postswallow hypopharyngeal reflux was predictive of a diverticulum larger than 1 cm and may be useful in surgical planning. Zenkers diverticulum surgery method l cervical incision, vertical myotomy several cm on either side of base of diverticulum, remove or suspend diverticulum, leave drains postop cricopharyngeal myotomy. The etiology of zenkers diverticulum has been a topic of much debate, but increased intraluminal pressure from cp muscle dysfunction is most often implicated. Sometimes, other conditions are present alongside zenker s. Zenkers diverticulum zd is an uncommon but highly treatable cause of dysphagia. Distinguish the best imaging modality to diagnose zenkers diverticulum.
It is more prevalent in men than in women and typically presents in the seventh and eighth decades of life. It represents 70% of all cases of diverticula, followed by traction diverticula 20% and epiphrenic diverticula 10%. When a diverticulum increases in size, the following symptoms may appear. Zenkers diverticulum uc davis center for voice and. Most often found in individuals over the age of 50 but possible at even younger ages, zenkers diverticulum is a disorder of the throat in which a diverticulum, a pouch, develops in the throat wall. Zenkers diverticulum location, symptoms, treatment, diet. Zenkers diverticulum is a rare, benign throat disorder seen mainly in elderly people. The treatment for a zenkers diverticulum is cutting the cricopharyngeus muscle, known as a cricopharyngeal myotomy. Food may accumulate in the pouch, causing it to fill and at times regurgitate up.
Is a swelling or pulsion that forms at the back of the throat at the junction of the pharynx and esophagus in older. Fibreoptic diverticular repair is another of the methods for treating zenkers diverticulum. Another patient had total dysphagia of 3 days duration because of food impaction in the zenkers diverticulum along with intense dehydration with hypotension and mental confusion. Endoscopic laserassisted diverticulotomy versus open surgical approach in the treatment of zenker s diverticulum. Esophageal diverticula pleural of diverticulum are classified by their location within the esophagus. The effectiveness of myotomy of the cricopharyngeus as the sole treatment of zenkers diverticulum has been demonstrated in multiple studies. More detailed information about the symptoms, causes, and treatments of zenker s diverticulum is available below. It is an outpouching that develops in a weakened area at the back of the throat. Baron also discusses traditional surgical management, as well as endoscopic treatment of zenker s diverticulum. Materials and methods patients and controls we studied 14 consecutive patients 9 male, 5 fe.
Endoscopic laserassisted diverticulotomy versus open surgical approach in the treatment of zenkers diverticulum. Upper endoscopy revealed a small zenkers diverticulum as well as another. Todd baron defines zenkers diverticulum and its symptoms. Anatomically there is a loose bulge of the dorsal wall of the hypopharynx. Zenkers diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. Zenkers diverticulum zd or pharyngeal pouch is a rare esophageal disorder with an annual incidence of just 2 per 100,000. Zenkers diverticulum repair what is zenkers diverticulum.