Zenker’s Diverticulum: Causes, Symptoms, Treatment, Diagnosis

Zenker’s diverticulum (pharyngeal pouch/hypopharyngeal diverticulum/ pharyngoesophageal diverticulum) is a diverticulum which is formed from the mucosa of the pharynx and is situated above the cricopharyngeal muscle, which is present above the upper sphincter of the esophagus. Zenker’s diverticulum is a false diverticulum, as it does not involve all the layers of the esophageal wall. Zenker’s diverticulum was named by Friedrich Albert von Zenker, who was a German pathologist, in 1877.

The main cause of Zenker’s Diverticulum is thought to be malfunctioning of the cricopharyngeal muscle due to the aging process. Neurologic medical conditions, such as a stroke, also can cause malfunctioning of the cricopharyngeal muscle. Excessive pressure in the lower pharynx causes ballooning out of the weakest part of the pharyngeal wall resulting in formation of diverticulum, which can be many centimeters in diameter.

According to current research, occlusive mechanisms are thought to play an important role in formation of Zenker’s Diverticulum, such as impaired relaxation, uncoordinated swallowing, and spasm of the cricopharyngeus muscle; all these things lead to increased pressure in the distal pharynx which leads to its herniation through the point of least resistance. This point is known as Killian’s triangle, which is situated superior to the cricopharyngeus muscle and lower to the inferior constrictor muscles. This causes outpouching of the posterior pharyngeal wall, which is just above the esophagus.

Zenker’s diverticulum can be asymptomatic; however, the following symptoms can be present:

• Dysphagia (difficulty swallowing) with a feeling of lump in the throat.
• Food can get trapped in the outpouching, which can cause regurgitation which is the reappearance of ingested food in the mouth).
• Pain can be experienced very rarely.
• Halitosis, which is bad breath, due to stagnant food being digested by microorganisms.
• Cough can occur due to the regurgitated food into the airway.
• Infection.
• Cervical webs can be seen in half of the patients with this condition.
• Feeling of a lump in the neck.
• Involuntary gurgling noises when the patient is swallowing.
• Hoarseness (changes in voice).
• Pneumonia can occur due to aspiration of the food present in the windpipe.

• A barium swallow helps in revealing the diverticulum.
• Upper GI endoscopy can also help in identifying the diverticulum.
• CT with oral contrast can also be done.

• Treatment is not needed if the diverticulum is small and asymptomatic.
• If the diverticulum is large and causes symptoms in the patient, then it is usually treated with a surgical procedure in the neck where the diverticulum is resected and the cricopharyngeal muscle is incised.
• Recently, non-surgical endoscopic methods have become more popular, as they have a faster recovery time. Endoscopic stapling is the currently preferred treatment for
• Zenker’s Diverticulum, i.e. diverticulectomy with staples. This procedure is done through a diverticuloscope.
• Endoscopic laser is a non-surgical treatment method for Zenker’s Diverticulum; however, it is less effective than stapling.
• Fibreoptic diverticular repair is another of the methods for treating Zenker’s diverticulum.