Snapshot A 59-year-old man presents to the clinic for complaints of bad breath and recurrent coughing spells. He complains difficulty swallowing at times and is noted to have a moderately sized neck mass during physical examination. Introduction False diverticulum (sac-like outpouching of only the mucosa and submucosa) of the esophagus true diverticulum contains all layers of the intestinal wall Epidemiology incidence prevalence of 0.01 - 0.11% in the U.S.A. demographics 1.5:1 male predominance typically seen in middle-aged adults and older adults in 7-8th decade of life location occurs at the upper part of the esophagus at Killian triangle (an area of muscular weakness between the cricopharyngeus muscle and lower inferior constriction) Pathogenesis Killian triangle is a natural area of weakness within the muscular wall of the esophagus and is more common in men thought to result from chronic increased pressure on the weakened area due to either high intrabolus pressures during swallowing resistance to swallowing due to abnormalities of the upper esophageal sphincter Prognosis ranges widely depending on health of patient and surgical approach disease itself is rarely life-threatening Presentation Symptoms dysphagia regurgitation choking halitosis (bad breath) chronic cough Physical exam palpable, fluctuant neck mass Imaging Barium swallow preferred method of diagnosis will demonstrate dye collection posterior to the esophagus Transcutaneous ultrasound allows for differentiation from a thyroid/neck mass good alternative for people who have difficulties swallowing barium Esophageal manometry not required for diagnosis may help delineating the pathogenesis of the diverticulum Differential Achalasia distinguishing factor will demonstrate a bird’s beak on barium swallow Diffuse esophageal spasm distinguishing factor will have characteristic findings on esophageal manometry Treatment Conservative treatment if diverticulum is small and asymptomatic, no treatment is necessary Operative myotomy of cricopharyngeus muscle with diverticulum resection indication if the diverticulum is large and symptomatic endoscopic approach has better success rates compared to external approach Complications Aspiration pneumonia Squamous cell carcinoma of the diverticulum prevalence ranges from 0.3-7 % Ulceration and bleeding Increased risk of iatrogenic perforation
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.GI.15.75) A 73-year-old man presents with complaints of long standing halitosis. He has recently been having progressive difficulty with swallowing. In the last several weeks, he has also noticed a small amount of regurgitated food on his pillow in the morning. You obtain the radiographic study depicted in Figure A. What is the most likely diagnosis? QID: 106813 FIGURES: A Type & Select Correct Answer 1 Achalasia 7% (16/219) 2 Zenker's diverticulum 90% (197/219) 3 Squamous esophageal carcinoma 1% (2/219) 4 Esophageal adenocarcinoma 0% (1/219) 5 Diffuse esophageal spasm 0% (1/219) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (M1.GI.13.57) A 72-year-old Caucasian male presents to your office with dysphagia and halitosis. If this patient is also found to have cricopharyngeal muscle dysfunction, which of the following is the most likely cause of his presenting symptoms? QID: 101114 Type & Select Correct Answer 1 Gastroesophageal reflux disease 2% (8/329) 2 Esophageal candidiasis 3% (10/329) 3 Glossopharyngeal nerve damage 11% (36/329) 4 Meckel's diverticulum 2% (6/329) 5 Zenker's diverticulum 80% (264/329) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (1) Login to View Community Videos Login to View Community Videos Endoscopic Zenker's diverticulum repair Thomas Heineman Gastrointestinal - Zenker Diverticulum D 2/3/2015 74 views 5.0 (1)