Zenker diverticulum

Zenker diverticulum, also known as a pharyngeal pouch, is a posterior outpouching of the hypopharynx, just proximal to the upper esophageal sphincter through a weakness in the muscle layer called the Killian dehiscence.

More than 50% of the affected patients present in 60-80 years of life.

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

A Zenker diverticulum is a pulsion-pseudodiverticulum and results from herniation of mucosa and submucosa through the Killian triangle (or Killian dehiscence), a focal weakness in the hypopharynx at the normal cleavage plane between the fibers of the two parts of the inferior pharyngeal constrictor muscle - the cricopharyngeus and thyropharyngeus. 

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 esophagus.

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

  • a diverticulum arising from the midline of the posterior wall of the distal pharynx near the pharyngoesophageal junction
    • the outpouching may be transient, and some refer to the transient variety as a "pharyngeal pouch"
  • 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

Since ~90% of patients with a Zenker diverticulum have a hiatal hernia and gastro-esophageal reflux, the distal esophagus should also be evaluated.

In addition to the clinical symptoms mentioned above, patients with a Zenker diverticulum are at increased risk for aspiration.

A Zenker diverticulum may be surgically treated with an endoscopic, surgical diverticulectomy, or diverticulopexy.

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

Anatomy: Thoracic
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Article information

rID: 2297
Synonyms or Alternate Spellings:
  • Zenker's diverticulum
  • Pharyngeal pouch
  • Zenker's diverticula
  • Zenker diverticula
  • Zenkers diverticulum
  • Zenkers diverticula
  • Pharyngeal pouches
  • Pouch of the hypopharynx
  • Hypopharyngeal pouch

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Cases and figures

  • Case 1: lateral oesophogram
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  • Case 2: sagittal CT
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  • Case 2: axial CT
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  • Case 3: with perforation
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  • Case 4: lateral view
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  • Zenker diverticul...
    Case 5: frontal view
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  • Case 6: cinefluoroscopy of a Zenker diverticulum
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  • Case 7
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  • Case 8
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