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Query: UMLS:C0232605 (regurgitation)
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Zenker's diverticulum is a pulsion typed pharyngoeosophageal diverticle caused by the herniation of the pharyngeal mucosa, standing beside the posterior pharyngeal wall, through the Killian opening which is known as the weak area between the inferior constructor muscle's oblique fibres and transverse fibres of cricopharyngeal muscle. In patients with Zenker's diverticulum, symptoms such as disfagia, globus in the cervical area, weigh loss, regurgitation, cough, and aspiration. These patients are primarily admitted to the Gastroenterology and Othorhinolaryngology clinics with the complaint of disfagia and the diagnosis of this disease is mostly established late and the treatment is started late because the results of their physical examinations seem normal. Therefore, especially in the patients who have disfagia complaint, pharyngoeosophageal diverticle prediagnosis should be thought and that should be examined by passage graphies with barium and endoscopic methods, if needed. In this article, we presented the 67-year-old Zenker's diverticulum patient in whom we performed open diverticulectomy and posterior cricopharyngeal myotomy, and we specified the important points in choosing the patient and the type of surgery.
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PMID:[Zenker diverticulum: a case report]. 2003 Jun 1

Zenker's diverticulum is one of the most common esophageal diverticuli. The reported prevalence in Czech population is approx. 0.5%, typically presents in the elderly. A small Zenker's diverticulum can be asymptomatic. When a diverticulum increases in size, it can cause regurgitation and dysphagia and the condition is often complicated by aspiration and reccurent pneumonia. The diagnosis can be made on a barium esophagogram and CT scan. Surgical therapy is the treatment most commonly offered and the prognosis is excellent. Here we report a 66-years-old male presenting with bleeding from large Zenker's diverticulum. He was immediately admitted to hospital. A computed tomography scan showed a large Zenker's diverticulum protruding into the right superior hemithorax. Resection was chosen as a therapeutic option. Due to the size of the diverticuli his recovery post operation was complicated by fever, bleeding into mediastinum from the place of resection and temporary functional esophagi disorder. Histological examination confirmed ulceration inside the diverticulum as the source of bleeding. Three weeks after the surgery the patient was discharged home in a stable condition with recovered swallowing and phonation.
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PMID:[Giant Zenker's diverticulum--case report]. 2202 88

A Zenker's diverticulum is a blind pouch that branches off the cervical esophagus. Affected individuals may suffer from long-standing swallowing difficulties, regurgitation, bad breath, weight loss, and even aspiration.. Here we report a 80-years-old male presenting with dysphagia and regurgitation. Barium swallow reported the presence of a Zenker's diveticulum. In view of the patient's age, endoscopic diathermy was considered as a therapeutic option for the management.
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PMID:Zenker's diverticulum - a case report. 2312 Jun 10

Zenker's diverticulum or pharyngeal pouch is a herniation of pharyngeal mucosa through a defect located on the posterior pharyngeal wall, in an area of natural weakness between the 2 parts of the inferior constrictor muscles. The incidence of presentation of pharyngeal pouch to an ear, nose, throat (ENT) specialist was estimated as 0.47 cases per 100,000 per year. It could be a rare cause of dysphagia in elderly patients, associated with regurgitation, chronic cough, aspiration, and weight loss. The etiology still unknown, but theories focus upon structural or physiological disorders of the cricopharyngeus muscle. Zenker's diverticulum should be considered as one of the rare causes of dysphagia in elderly patients, and the treatment modalities depend on individual experience and availability of the facilities.
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PMID:Zenker's diverticulum. A rare cause of dysphagia. 2329 66

Rapid sequence induction and intubation (RSII) and awake tracheal intubation are commonly used anesthetic techniques in patients at risk of pulmonary aspiration of gastric or esophageal contents. Some of these patients may have a gastric tube (GT) placed preoperatively. Currently, there are no guidelines regarding which patient should have a GT placed before anesthetic induction. Furthermore, clinicians are not in agreement as to whether to keep a GT in situ, or to partially or completely withdraw it before anesthetic induction. In this review we provide a historical perspective of the use of GTs during anesthetic induction in patients at risk of pulmonary aspiration. Before the introduction of cricoid pressure (CP) in 1961, various techniques were used including RSII combined with a head-up tilt. Sellick initially recommended the withdrawal of the GT before anesthetic induction. He hypothesized that a GT increases the risk of regurgitation and interferes with the compression of the upper esophagus during CP. He later modified his view and emphasized the safety of CP in the presence of a GT. Despite subsequent studies supporting the effectiveness of CP in occluding the esophagus around a GT, Sellick's early view has been perpetuated by investigators who recommend partial or complete withdrawal of the GT. On the basis of available information, we have formulated an algorithm for airway management in patients at risk of aspiration of gastric or esophageal contents. The approach in an individual patient depends on: the procedure; type and severity of the underlying pathology; state of consciousness; likelihood of difficult airway; whether or not the GT is in place; contraindications to the use of RSII or CP. The algorithm calls for the preanesthetic use of a large-bore GT to remove undigested food particles and awake intubation in patients with achalasia, and emptying the pouch by external pressure and avoidance of a GT in patients with Zenker diverticulum. It also stipulates that in patients with gastric distension without predictable airway difficulties, a clinical and imaging assessment will determine the need for a GT and in severe cases an attempt to insert a GT should be made. In the latter cases, the success of placement will indicate whether to use RSII or awake intubation. The GT should not be withdrawn and should be connected to suction during induction. Airway management and the use of GTs in the surgical correction of certain gastrointestinal anomalies in infants and children are discussed.
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PMID:Gastric tubes and airway management in patients at risk of aspiration: history, current concepts, and proposal of an algorithm. 2455 95

A 72-year-old woman presented with long-standing gastro-oesophageal reflux, regurgitation of swallowed food and worsening cervical dysphagia. Fluoroscopic barium oesophagography revealed a posterolateral pharyngeal pouch (Zenker's diverticulum (ZD)) complicating a 'cup and spill' oesophageal deformity with a smoothly tapered segment at the gastro-oesophageal junction. CT and high-resolution manometry confirmed that the underlying abnormality was a massively dilated oesophagus with aperistalsis and pan-oesophageal pressurisation, consistent with a diagnosis of oesophageal achalasia (type II). She underwent endoscopic stapled diverticulotomy, with good symptomatic relief. We discuss the aetiology of ZD, its management and the association here with oesophageal achalasia.
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PMID:Zenker's diverticulum complicating achalasia: a 'cup-and-spill' oesophagus. 2433 71

The cricopharyngeal diverticulum or Zenker's diverticulum is the most frequent type of diverticulum of the upper gastrointestinal tract. It occurs mostly in elderly patients. The predominant symptoms are dysphagia and regurgitation which may result in malnutrition and aspiration pneumonia, the latter eventually being life threatening. The underlying cause of Zenker's diverticulum is a dysfunction of the cricopharyngeal muscle and the upper esophageal sphincter, the most common finding being a decreased compliance. The treatment consists in a myotomy of the upper esophageal sphincter and cricopharyngeal muscle combined with a diverticulopexy or diverticulectomy. This procedure is performed via a limited left cervicotomy. Results are excellent to very good in 94% of the patients in our own experience.
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PMID:Zenker's diverticulum. 2441 52

The pharyngeal pouch (Zenker's diverticulum) is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the oesophagus). It occurs commonly in elderly patients (over 70 year) and the typical symptoms include dysphagia, regurgitation, chronic cough, aspiration and weight loss. We are reporting a case of an oropharyngeal dysphagia due to a Zenker's diverticulum in 75 years old Sudanese man with a chronic history of dysphagia for solids. The pathophysiology of Zenker's diverticulum, clinical presentation, and management are reviewed.
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PMID:Zenker's diverticulum: a case report and literature review. 2530 67

Zenker's diverticulum (ZD), also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2-6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up.
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PMID:Zenker's Diverticulum: Diagnostic Approach and Surgical Management. 2575 30

Zenker's diverticulum is the most common type of diverticulum in the esophagus. Most patients are elderly. Typical symptoms are regurgitation, dysphagia, halitosis and chronic cough. The most common treatments are open surgical diverticulectomy with cricopharyngeal myotomy or diverticulopexy. Most instances of esophageal perforation are iatrogenic. Rapid diagnosis and therapy provide the best chance for survival. If diagnosed early, cervical esophageal perforations can be treated conservatively if there are no signs of systemic sepsis. In this case report a conservatively treated cervical esophageal diverticulum perforation is presented.
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PMID:Iatrogenic Zenker's diverticulum perforation: A conservatively treated case. 2593 24


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