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Zenker's diverticulum

Dr Hani Alsalam and Dr Abhijit Datir et al.

A Zenker's diverticulum (also known as a pharyngeal pouch) is an outpouching of mucosa in the hypopharynx just proximal to the upper oesophageal sphincter. It is located in the posterior midline at the cleavage plane (known as Killian dehiscence) between the circular and oblique fibers of the cricopharyngeus muscle.

Epidemiology

Most common affects the elderly; > 50% of the affected patients present in 7^th or 8^th decades of life.

Clinical presentation

The entrapment of liquid and/or food within the pouch or diverticulum may result in:

Pathophysiology

The Zenker's diverticulum is a pulsion-pseudodiverticulum and results from herniation of mucosa and submucosa through the dehiscence of Killian, a focal weakness in the hypopharynx at the normal cleavage plane between the fibers of the inferior pharyngeal constrictor and the cricopharyngeus muscles.

This phenomenon may lead to the creation of a sac with a narrow neck that can trap liquid and food. The distended sac may compress the cervical oesophagus.

Radiographic features

Fluoroscopy

Ideally a barium swallow examination is performed, which may show:

an (intermittent) outpouching arising from the midline of the posterior wall of the distal pharynx near the pharyngoesophageal junction.
the pouch is best identified during swallowing and is best seen on the lateral view, on which the diverticulum is typically noted at the C5-6 level.

Etymology

It is named after Friedrich Albert von Zenker who was a German pathologist (1825 - 1898) who held a position as teacher and researcher for more than 30 years at the university of Erlangen.