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.
Most common affects the elderly; > 50% of the affected patients present in 7th or 8th decades of life.
The entrapment of liquid and/or food within the pouch or diverticulum may result in:
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.
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.
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.
- 1. Siddiq MA, Sood S, Strachan D. Pharyngeal pouch (Zenker's diverticulum). Postgrad Med J. 2001;77 (910): 506-11. doi:10.1136/pmj.77.910.506 - Free text at pubmed - Pubmed citation
- 2. Brant WE, Helms CA. Fundamentals of diagnostic radiology. Lippincott Williams & Wilkins. (2007) ISBN:0781765188. Read it at Google Books - Find it at Amazon
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