Presentation
Presenting with complaints of food/pills getting stuck, regurgitation and halitosis
Patient Data
Normal act of swallowing motion. There is a moderate size Zenker's diverticulum at the C5 spinal level. The diverticular neck is approximately 6 mm and neck to base diameter is approximately 17 mm. Contrast remains within the Zenker's diverticulum. Just below the level of the diverticulum neck, there is smooth narrowing of the lumen of the esophagus, likely a combination of extrinsic compression and muscular spasm of the cricopharyngeus. No further obstruction and contrast advances into stomach.
Case Discussion
This patient presented with classic symptoms of halitosis, regurgitation and the complaint of food and pills getting stuck. For this reason she got a fluoroscopic study of the esophagus with barium to evaluate for structural abnormalities. The images showed a posterior collection of barium as the patient was asked to swallow. This points to the diagnosis of a Zenker’s Diverticulum.
A Zenker’s diverticulum occurs at Killians triangle. This is the area between the cricopharyngeus muscle and the lower inferior constriction. The area is a point of weakness and chronic pressure on the area can cause an outpouching diverticulum. It is a false diverticulum which means it only involves the mucosa and submucosa.
Although Zenker’s is more common in men, as seen in this patient women can develop it as well. The mainstay of treatment in symptomatic patients is surgery. Typically an endoscopic cricopharyngeus myotomy with diverticulum resection is done.
Complications, if left untreated, include squamous cell carcinoma of the esophagus and aspiration pneumonia as well as asphyxiation.
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