Zenker diverticulum

Case contributed by Yaïr Glick

Presentation

ERCP endoscope cannot be introduced into esophagus - diverticulum?

Patient Data

Age: 80 years
Gender: Male
Fluoroscopy

Zenker diverticulum identified, its neck at level of C6.
Tertiary esophageal contractions.
No hiatal hernia demonstrated.
No evidence of gastroesophageal reflux during the examination.

Case Discussion

The patient developed ascending cholangitis due to a biliary calculus in the distal common bile duct (CBD). The ERCP endoscope could not be introduced into the esophagus, nor a more slender gastroscope. This was explained by the identification of a Zenker diverticulum at fluoroscopy.

Zenker diverticulum is a pulsion diverticulum, meaning that it is caused by raised pressure in the esophagus, attributed to cricopharyngeal spasm. It is actually a pseudodiverticulum, meaning that the mucosa and submucosa bulge out through the muscularis propria.

Treatment of Zenker diverticulum consists mainly of cricopharyngeal myomectomy and resection of the diverticulum.

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