Zenker's Diverticulum

An outpouching of the posterior pharyngeal wall immediately above the upper esophageal sphincter.

Zenker's diverticulum may occur because of decreased compliance of the cricopharyngeal muscle with premature closure of the upper esophageal sphincter. It may be asymptomatic, although symptoms may develop if the outpouching becomes large. Symptomatic patients are usually >= 50 years. The most common symptoms include dysphagia for solids and liquids, cough, regurgitation of undigested food, recurrent aspiration, bronchitis, halitosis, and recurrent pneumonia. A mass in the left neck may be seen while the patient is eating and may produce esophageal compression, contributing to and worsening the dysphagia.

Zenker's diverticulum is diagnosed by barium swallow. Patients with dysphagia may practice various maneuvers (eg, applying pressure to the neck, coughing repeatedly to empty the diverticulum) to assist swallowing. The treatment for symptomatic patients is cricopharyngeal myotomy with diverticulectomy. Diverticulopexy has been performed for large diverticula, orienting the lumen caudally. Small diverticula are usually not resected.