Presentation
ERCP endoscope cannot be introduced into oesophagus - diverticulum?
Patient Data
Zenker diverticulum identified, its neck at level of C6.
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 oesophagus, 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 oesophagus, 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.