Pharyngeal pouch (zenkers diverticulum)

General or Other | - Others | Pharyngeal pouch (zenkers diverticulum) (Disease)


Description

A pharyngeal pouch represents a posteromedial pulsion diverticulum through Killians dehiscence. It is a herniation between the thyropharyngeus and cricopharyngeus muscles that are both part of the inferior constrictor of the pharynx.

Pharyngeal pouches occur most commonly in elderly patients (over 70 years) and typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss.

Causes and Risk factors

The condition is twice as common in women as in men. It is not clear what causes it, although it is likely poor co-ordination in the throat muscles may cause it.

As the pouch enlarges, it can collect undigested food which may then be regurgitated. Other symptoms include waking in the night with a sense of blockage in the throat or bouts of coughing - a symptom that may be mistaken for acid reflux.

Diagnosis and Treatment

Usually this is the differential diagnosis of dysphagia and must include oesophageal carcinoma and oesophageal strictures, rings and webs.

Treatment is surgical via an endoscopic or external cervical approach and should include a cricopharyngeal myotomy. Unfortunately pharyngeal pouch surgery has long been associated with significant morbidity, partly due to the surgery itself and also to the fact that the majority of patients are elderly and often have general medical problems.

Recently, treatment by endoscopic stapling diverticulotomy has becoming increasingly popular as it has distinct advantages, although long term results are not yet available. There is some evidence that, whilst endoscopic surgery is safer for the elderly and frail, there may be a higher rate of recurrence and the conversion to an open procedure may be required if there are technical difficulties or perforation during operation.

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