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Zenker diverticulum

Dr Daniel J Bell ◉ and R Bronson et al.

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.

On this page:

Article:

Epidemiology
Clinical presentation
Pathology
Radiographic features
Treatment and prognosis
History and etymology
See also
Related articles
References

Images:

Cases and figures

Epidemiology

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

Clinical presentation

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

globus sensation
dysphagia
halitosis
regurgitation
cough
infection

Pathology

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.

Radiographic features

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-esophageal reflux, the distal esophagus should also be evaluated.

Treatment and prognosis

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.

History and etymology

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.

See also

Quiz questions

References

Anatomy: Thoracic

thoracic skeleton
- thoracic cage
  - ribs
    - typical ribs
    - atypical ribs
    - variant anatomy
      - bifid ribs
  - costal cartilage
  - sternum
- thoracic spine
- articulations
muscles of the thorax
spaces of the thorax
thoracic viscera
blood supply of the thorax
- arteries
  - thoracic aorta (development)
  - pulmonary trunk
    - left pulmonary artery
      - aberrant left pulmonary artery
    - right pulmonary artery
- veins
  - superior vena cava (cavoatrial junction)
  - inferior vena cava
  - coronary veins
    - cardiac veins which drain into the coronary sinus
      - great cardiac vein
      - middle cardiac vein
      - small cardiac vein
      - posterior vein of the left ventricle
      - vein of Marshall (oblique vein of the left atrium)
    - anterior cardiac veins
    - venae cordis minimae (smallest cardiac veins or thebesian veins)
  - pulmonary veins
    - bronchial veins
lymphatics
innervation of the thorax

Article information

rID: 2297

System: Gastrointestinal, Head & Neck

Tag: pharynx, hypopharynx, diverticulum, pouch, neck, fluoroscopy, esophogram

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 Case 1: lateral oesophogram

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Case 2: sagittal CT Case 2: sagittal CT

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Case 2: axial CTCase 2: axial CT

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Case 3: with perforationCase 3: with perforation

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Case 4: lateral viewCase 4: lateral view

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Zenker diverticul...

Case 5: frontal viewCase 5: frontal view

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Case 6: cinefluoroscopy of a Zenker diverticulumCase 6: cinefluoroscopy of a Zenker diverticulum

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Case 7Case 7

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Case 8Case 8

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