Esophageal diverticulum

Esophageal diverticula are sac or pouch projections arising from the esophagus.

Epidemiology

They can occur in all ages but more frequent in adults and elderly people.

Pathology

Esophageal diverticula are either:

• true diverticula: include all esophageal layers
• false diverticula: contain only mucosa and submucosa herniating through the muscular layer (e.g. Zenker diverticulum)

Esophageal diverticula are classified according to the mechanism of formation into:

• traction diverticula: occurs secondary to pulling forces on the outer aspect of the esophagus
• pulsion diverticula: occurs secondary to increased intraluminal pressure (e.g. Zenker diverticulum)

Classification

They can be classified according to their location:

Upper esophageal diverticula

• Zenker diverticulum: actually pharyngeal but it is common practice to include it with esophageal diverticula
• Killian-Jamieson diverticulum

Middle esophageal diverticula

• traction diverticula: are (true diverticula) which occur secondary to scarring, fibrosis and inflammatory processes (tuberculous adenitis) in the mediastinum pulling on the esophageal wall
• pulsion diverticula: are usually false diverticula and occur secondary to abnormal increased intraluminal pressure against a weak esophageal segment

Lower esophageal diverticula

• epiphrenic diverticula