Dysphagia in an Elderly Patient

An elderly man presented with dysphagia to solids. The patient also complained of partially digested food drooling out of his mouth while he slept. A barium esophagogram revealed a 40-mm posterior protrusion at the level of the proximal cervical esophagus. On EGD a diverticulum was seen.

Zenker's diverticulum, also known as pharyngeal pouch, is really a pseudodiverticulum, as it only contains mucosa and submucosa and does not involve all the layers of the esophageal. This pseudodiverticulum results from posterior herniation of esophageal mucosa into Killian's triangle, an area of least resistance situated above the upper esophageal sphincter (cricopharyngeal muscle) and below the inferior pharyngeal constrictor muscle.

Symptoms of Zenker’s diverticulum are dysphagia, and the pooling of food within the diverticulum, which can cause bad breath, frequent regurgitation and aspiration pneumonia.

Treatment consists of a surgical transcervical diverticulectomy without myotomy, diverticulopexy or endoscopic myotomy of the septum (i.e. longitudinal incision and dissection into the anterior septum). A myotomy can be accomplished using rigid or flexible endoscopes. Nowadays, most myotomies are performed by interventional endoscopists and ear nose and throat (ENT) specialists.

Additional Zenker Resources on EndoCollab