Zenker (Esophageal) Diverticulum

Protrusion of pharyngeal mucosa develops at the pharyngoesophageal junction between the inferior pharyngeal constrictor and the cricopharyngeus

Loss of elasticity of the upper esophageal sphincter, resulting in restricted opening during swallowing, is believed to be the cause

Dysphagia and regurgitation tend to develop insidiously over years in older predominantly male patients

Initial symptoms include vague oropharyngeal dysphagia with coughing or throat discomfort

As the diverticulum enlarges and retains food, patients may note

• Halitosis

• Spontaneous regurgitation of undigested food

• Nocturnal choking

• Gurgling in the throat

• Protrusion in the neck

Complications

• Aspiration pneumonia

• Bronchiectasis

• Lung abscess

Video esophagography is the best method to establish diagnosis

Observation is sufficient for small asymptomatic diverticula

Upper esophageal myotomy is required for symptomatic patients