Zenker diverticulum

Zenker diverticulum, also known as a pharyngeal pouch, is an outpouching at the level of the hypopharynx, just proximal to the upper oesophageal sphincter. It is located in the posterior midline at the cleavage plane between the thyropharyngeus muscle and the cricopharyngeus muscle (known as the Killian dehiscence or Killian triangle).

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 dehiscence of Killian), a focal weakness in the hypopharynx at the normal cleavage plane between the fibres of the inferior pharyngeal constrictor (thyropharyngeus muscle) 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.

Fluoroscopy 

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-oesophageal reflux, the distal oesophagus 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 or 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.

Thoracic anatomy
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Article information

rID: 2297
Synonyms or Alternate Spellings:
  • Zenker's diverticulum
  • Pharyngeal pouch
  • Zenker's diverticula

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Cases and figures

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    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: oblique oesophogram
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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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