Zenker’s diverticulum

Discussion in 'MRCS Forum' started by Smarti., May 27, 2008.

  1. Smarti.

    Smarti. Guest

    Zenker’s diverticulum

    An elderly nursing home patient complains of swallowing difficulty and choking on food. The physician on call orders a barium swallow, and an outpouching in the right neck is observed. True statements regarding Zenker’s diverticulum include -

    a- Aspiration pneumonitis is unlikely
    b- It is a congenital abnormality
    c- The most common symptom is a sensation of high obstruction on swallowing
    d- It is a traction-type diverticulum
    e- Treatment is restriction of certain foods
  2. Smarti.

    Smarti. Guest

    Answer: c. (Schwartz, 7/e, pp 1125) Zenker’s diverticulum is an acquired abnormality. Premature contraction of the cricopharyngeus muscle on swallowing, which leads to partial obstruction, is believed to be the cause of this pulsion-type diverticulum of the pharyngoesophageal junction. High intraluminal pressure results in an outpouching of mucosa through the oblique fibers of the pharyngeal constrictors. Dysphagia is common and is the usual presenting symptom. The diagnosis is established by barium swallow. Treatment is surgical: diverticulectomy or suspension of the diverticulum is usually recommended. Because the diverticulum is located above the superior esophageal sphincter, no mechanism exists to prevent aspiration of the contents of the diverticulum. Pulmonary complications are common.

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