Patients complain of dysphagia, retrosternal pain, feelings of pressure, and nightly regurgitation of undigested food residue. Todd baron defines zenkers diverticulum and its symptoms. Dysphagia that is the result of persistent cricopharyngeal spasm andor a zenkers diverticulum is particularly amenable to surgical correction. This relatively uncommon disorder, which occurs more commonly in the elderly, presents with symptoms of dysphagia. Transoral endoscopic excision of zenker s diverticulum. Zenkers diverticulum zd is an outpouching of tissue through killians triangle thought to be due to cricopharyngeal muscle dysfunction. Zenkers diverticulum is a rare disease, which can cause considerable suffering. Zenkers or cricopharyngeal diverticula are pulsion diverticula which form as a result. A condition that progressively worsens over time, esophageal diverticulum most often strikes adults over 60 years of age. Typical symptoms are regurgitation, dysphagia, halitosis and chronic cough. Zenkers diverticulum location, symptoms, treatment. Open surgery and rigid endoscopy have previously been the primary modalities for therapy, however with a favorable safety profile and similar success rates, flexible.
Most often found in individuals over the age of 50 but possible at even younger ages, zenker s diverticulum is a disorder of the throat in which a diverticulum, a pouch, develops in the throat wall. A zenkers diverticulum is a pouch that forms at the end of the throat and the beginning of the esophagus the swallowing tube. The pathophysiology of zenkers diverticulum, clinical presentation, and. Flexible endoscopic zenkers diverticulotomy with a novel bipolar forceps. Endoscopic management of zenkers diverticulum practical. It is a rare disease typically seen in the middleaged and older adults. Most instances of esophageal perforation are iatrogenic. The latter is associated with risks of aspiration and. Chhetri md, in dysphagia evaluation and management in. The endoscopic treatment of zd entails division of the septum between the diverticulum and the esophagus which also contains the cricopharyngeal muscle 68. It involves an openneck operation where thezenkers hernia. Disruption of the ability to swallow, known as dysphagia, can compromise nutrition. Food may accumulate in the pouch, causing it to fill and at times regurgitate up. The surgery is designed to release the tightened cricopharyngeal muscle, often in conjunction with removal of the zenkers diverticulum sac.
Zenkers diverticulum is a pouch at the back of the throat at a weak spot where the throat and esophagus join. A new treatment for zenkers diverticulumsubmucosal. Patients often present with a longstanding history of gradually increasing dysphagia of both solids and liquids. Management of zenker and hypopharyngeal diverticula richard. Endoscopic stapling is the currently preferred treatment for zenkers diverticulum, i. The only treatment to cure zenkers diverticulum is a surgical intervention, which relieves symptoms and improves the quality of life. Zenkers diverticulum tough to swallow cornerstone ear.
Dysphagia evaluation and management in otolaryngology. The predominant symptom of zd is dysphagia, and the most serious consequence is pulmonary aspiration. Zenkers diverticulum is a sac at the bottom of the throat. Dysphagia after endoscopic repair of zenkers diverticulum. Over a lifetime of swallowing, when there is excessive pressure within the lower portion of the pharynx the back wall of the throat, the weakest portion of the pharyngeal wall balloons out. Zenkers diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle. Zenkers diverticulum is a rare condition in which a pouch forms at the junction of the pharynx and the esophagus. Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa through killians triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor ie, thyropharyngeus muscle. On xray, the diverticulum appears as a round balloon that fills with radiopaque material as the patient swallows. Dysphagia difficulty swallowing regurgitation return of undigested food back into the mouth sense of a lump in the neck. After the swallow, the diverticulum usually empties of material logemann, 1998. Patients with this condition often exhibit no symptoms. Zenkers diverticulumcausessymptomstreatmentdiagnosis. An esophageal diverticulum is an outpouching that develops in a weakened area of the esophagus.
Zenkers diverticulum is a type of diverticulum that develops in the. Endoscopic diagnosis and management of zenkers diverticula. Table 231 presenting symptoms in patients with a zenkers diverticulum zenkers diverticula may be discovered incidentally during barium swallow or upper endoscopy carried. It is more prevalent in men than in women and typically presents in the seventh and eighth decades of life. Show full abstract a zenkers diverticulum in 75 years old sudanese man with a chronic history of dysphagia for solids. Click here to jump down to questions about treatment. Zenkers diverticulum zd, also known as cricopharyngeal. This book is distributed under the terms of the creative commons. A diverticulum is a blind sac that branches off from a cavity of the body. The zenkers diverticulum is an out pouching of the hypopharynx arising between the fibers of the cricopharyngeus inferiorly and the inferior constrictor superiorly. Zenkers diverticulum uc davis center for voice and. Zenkers diverticulum symptoms, diagnosis, treatments and.
Zenkers diverticulum zd is a saclike outpouching of the lining of the esophageal wall at the upper esophagus. A comprehensive literature search was completed to identify papers that examined the ef. Most often found in individuals over the age of 50 but possible at even younger ages, zenkers diverticulum is a disorder of the throat in which a diverticulum, a pouch, develops in the throat wall. In the lateral projection, the diverticulum can be adequately measured, especially as far as the distance from the septum to the bottom of the pouch is concerned, since this measure may guide the choice of the treatment. Is a swelling or pulsion that forms at the back of the throat at the junction of the pharynx and esophagus in older. Zenkers diverticulum zd is an outpouching of tissue through the killian triangle that is believed to be caused by dysfunction of the cricopharyngeal muscle. As the pouch enlarges and dysphagia increases, symptoms become more. Diagnosis edit lateral xray of a zenkers diverticulum ap xray of a zenkers diverticulum a combination of the simple barium swallow and a thorough endoscopy will normally en. Textbook of surgery th edition 1986 sabiston dc jr, ed. Esophageal diverticula pleural of diverticulum are classified by their location within the esophagus. Zenkers diverticulum zd is an uncommon but highly treatable cause of dysphagia. Modified barium swallow showing a 2cm zenkers diverticulum white arrows. Symptoms of esophageal diverticula dysphagia and regurgitation. Zenkers diverticulum repair what is zenkers diverticulum.
This region of herniation is known as killians triangle. The increased pharyngeal pressure causes a pouch zd to develop through the. Flexible endoscopic treatment for zenkers diverticulum. Zenker s diverticulum and cp dysfunction fact and fiction joshua s. The most common form, zenkers diverticulum is found at the level of. Cricopharyngeal dysfunction and zenker diverticulum. Esophageal diverticulum in an infant with downs syndrome and type iii esophageal atresia.
While we encourage individuals to share their personal experiences with copd, please consult a physician before making changes to your own copd management plan. Treatment for zenkers diverticulum is aimed in alleviating the presenting symptoms of the client. A zenkers diverticulum zd is a blind sac pouch that branches off the cervical esophagus. It has been known that the best option for this condition is to do nothing. Management of zenkers diverticulum has dramatically progressed during past decades. Zenkers diverticulum and swallowing disorders treatment.
This shall only warrant for an intervention when it has come to a point of disability to the client. The most common form, zenkers diverticulum is found at the level of the lower neck and usually at the back of the throat. Zpoem overview this video, edited by mouen khashab, associate professor of medicine and director of therapeutic endoscopy, demonstrates zenkers diverticulum. The list of treatments mentioned in various sources for zenkers diverticulum includes the following list. A septum between the diverticulum and the lumen of the esophagus can develop and hamper the passage of food.
Endoscopic treatment for zenkers diverticulum is safe. Brandt, in brocklehursts textbook of geriatric medicine and gerontology seventh edition, 2010. Zenkers diverticulum and other esophageal diverticula. Esophageal diverticula can affect people of all ages, although most cases occur in middleaged and elderly individuals. Although zenkers diverticulum is the most common type of esophageal diverticulum, the true incidence is difficult to determine because so many people with the disorder. Zenker s diverticulum a sac or pouch in the back of the throat which causes difficulty swallowing by collecting and retaining food and saliva. Larger, symptomatic cases of zenkers diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. When a person swallows, the muscle at the top of the esophagus is supposed to open. Always seek professional medical advice about any treatment or change in treatment plans. This pouch typically causes problems by trapping food as it is being swallowed, leading to choking and aspiration.
Zenkers diverticulum zd is a saclike outpouching of the mucosa and submucosa. It is a pulsion diverticulum that is likely the result of poor coordination between the pharyngeal and upper esophageal sphincter contractions at an area of anatomical weakness. Zd is a relatively uncommon disorder occurring in the elderly. If small and asymptomatic, no treatment is necessary. It is a pouch that forms in your pharynx, an area just above your esophagus or swallowing tube. These diverticula are uncommon and tend to occur in elderly people. A diagnosis is easily established on barium studies. Pdf nursing approach to zenkers diverticulum surgery. This happens when there is pressure on your pharynx and it balloons out. This pocketlike structure can appear anywhere in the esophageal lining between the throat and stomach. The condition goes by several names, depending on the location of the pouch. A novel approach for the treatment of zenkers diverticulum. Zenkers diverticulum is a pseudodiverticulum of the esophagus that forms in the killians triangle, between the inferior pharyngeal.
An esophageal diverticulum is a pouch that protrudes outward in a weak portion of the esophageal lining. The most common treatments are open surgical diverticulectomy with cricopharyngeal myotomy or diverticulopexy. Zenker s diverticulum zd is a pharyngeoesophageal pulsion diverticulum which presents in the elderly and contributes to morbidity due to dysphagia and pulmonary aspiration. Management of zenker and hypopharyngeal diverticula. This method functionally joins the lumen of the diverticulum with that of the esophagus, thereby relieving the symptoms of dysphagia without actually resecting the diverticulum. Zenkers diverticulum a sac or pouch in the back of the throat which causes difficulty swallowing by collecting and retaining food and saliva. Since its early descriptions by collard and colleagues, the technique of transoral surgical treatment of zenkers diverticulum has continued to evolve. The aetiology remains unknown but theories centre upon a structural or physiological abnormality of the cricopharyngeus. Baron, in clinical gastrointestinal endoscopy third edition, 2019. Zenkers diverticulum zd or pharyngeal pouch is a rare esophageal disorder with an annual incidence of just 2 per 100,000. A novel device for exposing, stretching and fixing the septum, and optimizing the operative. Anatomically there is a loose bulge of the dorsal wall of the hypopharynx.
Zenkers diverticulum zd is a pharyngeoesophageal pulsion diverticulum which presents in the elderly and contributes to morbidity due to dysphagia and pulmonary aspiration. Baron also discusses traditional surgical management, as well as. Fibreoptic diverticular repair is another of the methods for treating zenkers diverticulum. Report a case of huge zenkers diverticulum with date. A new study reports that flexible endoscopic treatment of zenkers diverticulum by using a diverticuloscope offers a treatment modality with a very low complication rate. Endoscopic stapling technique for the treatment of zenker. Zenkers diverticulum is a pouch that forms at the back of the throat at the junction of the pharynx and the esophagus the food passage to the stomach. Pharyngeal pouch zenkers diverticulum postgraduate. Zenkers diverticulum an overview sciencedirect topics. Dysphagia cervical osteophytes dish esophageal diverticula.
Zenkers diverticulum is a rare, benign throat disorder seen mainly in elderly people. Pharyngeal pouches occur most commonly in elderly patients over 70 years and typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss. Background presently, the 2 most widely used methods for the treatment of zenker diverticulum are endoscopic stapling of the common party wall between the diverticulum sac and the esophagus and the standard openneck technique involving diverticulectomy and cricopharyngeal myotomy objective to perform an analysis of the hospital charges to determine the economic. Diverticulectomy is usually selected for treating large diverticula in otherwise healthy patients 1. Predominant symptoms are dysphagia and regurgitation. Common symptoms of the disease include difficulties in swallowing dysphagia, food reflux regurgitation, unpleasant breath smells halitosis and couch. Tranoral stapler zenkers repair technique sciencedirect. Transoral endoscopic excision of zenkers diverticulum.
It is an outpouching that develops in a weakened area at the back of the throat. A diverticulum is a side pocket that forms when pharyngeal or esophageal muscle herniates. More detailed information about the symptoms, causes, and treatments of zenkers diverticulum is available below. A zenkers diverticulum, more formally known as a hypopharyngeal diverticulum, is a pouch that can form at the junction of the hypopharynx lower part of the throat and the esophagus, an area known as killians triangle. Halitosis smelly breath due to stagnant food in the pouch. It is the most common type of esophageal diverticulum.
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