Zenker's diverticulum: Difference between revisions

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{{Infobox_Disease |
{{Infobox_Disease |
   Name          = Zenker's diverticulum |
   Name          = Zenker's diverticulum<br> Source:Radiopaedia<ref name="urlZenker diverticulum | Radiology Case | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/cases/zenker-diverticulum-7 |title=Zenker diverticulum &#124; Radiology Case &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref> |
   Image          = ZenkerSchraeg.gif |
   Image          = Zenker.gif|
   Caption        = |
   Caption        = |
   DiseasesDB    = 31174 |
   DiseasesDB    = 31174 |
  Source        = Radiopaedia.org |
   ICD10          = {{ICD10|K|22|5|k|20}} |
   ICD10          = {{ICD10|K|22|5|k|20}} |
   ICD9          = {{ICD9|530.6}} |
   ICD9          = {{ICD9|530.6}} |
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   OMIM          = |
   OMIM          = |
   MedlinePlus    = |
   MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 2777 |
   MeshID        = D016672 |
   MeshID        = D016672 |
}}
}}
{{SI}}
{{Zenker's diverticulum}}
{{CMG}}
'''For patient information, click [[Zenker's diverticulum (patient information)|here]]'''
 
{{Editor Help}}


==Overview==
{{CMG}} [[Associate editor-In-Chief|'''Associate editor-In-Chief''']]:{{Ajay}}


In [[anatomy]], '''Zenker's diverticulum''' is a [[diverticulum]] of the [[mucosa]] of the [[pharynx]], just above the [[cricopharyngeal muscle]] (i.e. above the upper [[sphincter]] of the [[oesophagus]]). It was named in 1877 by German [[pathologist]] [[Friedrich Albert von Zenker]].
{{SK}} Hypopharyngeal diverticulum, pharyngoesophageal diverticulum


==Epidemiology==
==[[Zenker's diverticulum overview|Overview]]==


Zenker diverticulum mainly affects older adults.
==[[Zenker's diverticulum historical perspective|Historical Perspective]]==


==Mechanisms and manifestations==
==[[Zenker's diverticulum classification|Classification]]==


In simple words, when there is excessive pressure within the lower [[pharynx]], the weakest portion of the pharyngeal wall balloons out, forming a [[diverticulum]] which may reach several centimetres in diameter.
==[[Zenker's diverticulum pathophysiology|Pathophysiology]]==


More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the [[cricopharyngeus]] muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (variously known as Killian's triangle, Laimer's triangle, or more accurately Killian-Laimer triangular dehiscence). The result is an outpouching of the posterior pharyngeal wall, just above the oesophagus.<ref>PMID 12903677 Pathogenesis and methods of treatment of Zenker's diverticulum, Ann Otol Rhinol Laryngol. 2003 Jul;112(7):583-93</ref>
==[[Zenker's diverticulum causes|Causes]]==


While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as [[dysphagia]] (difficulty swallowing),  and sense of a lump in the neck; moreover, it may fill up with food, causing [[regurgitation]] (reappearance of ingested food in the mouth), [[cough]] (as some food may be regurgitated into the airways) and [[halitosis]] (smelly breath, as stagnant food is digested by microrganisms). It rarely causes any pain.
==[[Zenker's diverticulum differential diagnosis|Differentiating Zenker's diverticulum from other Diseases]]==


==Diagnosis==
==[[Zenker's diverticulum epidemiology and demographics|Epidemiology and Demographics]]==


A simple [[barium swallow]] will normally reveal the [[diverticulum]]. This may be coupled with [[esophagoscopy]].
==[[Zenker's diverticulum risk factors|Risk Factors]]==


<gallery>
==[[Zenker's diverticulum screening|Screening]]==
Image:Esophageal-diverticulum-001.jpg|Barium swallow graphy: Zenker's diverticulum
Image:Esophageal-diverticulum-002.jpg|Barium swallow graphy: Zenker's diverticulum
Image:Esophageal-diverticulum-003.jpg|Barium swallow graphy: Zenker's diverticulum
</gallery>


==[[Zenker's diverticulum natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


<gallery>
==Diagnosis==
Image:Esophageal-diverticulum-004.jpg|Barium swallow graphy: Zenker's diverticulum
[[Zenker's diverticulum history and symptoms|History and Symptoms]] | [[Zenker's diverticulum physical examination|Physical Examination]] | [[Zenker's diverticulum laboratory findings|Laboratory Findings]] | [[Zenker's diverticulum electrocardiogram|Electrocardiogram]] | [[Zenker's diverticulum x ray|X Ray]] | [[Zenker's diverticulum CT|CT]] | [[Zenker's diverticulum MRI|MRI]] | [[Zenker's diverticulum ultrasound|Ultrasound]] | [[Zenker's diverticulum other imaging findings|Other Imaging Findings]] | [[Zenker's diverticulum other diagnostic studies|Other Diagnostic Studies]]
Image:Esophageal-diverticulum-005.jpg|Barium swallow graphy: Zenker's diverticulum
</gallery>
 
[[Image:ZenkerSchraeg.gif|thumb|left|Barium swallow graphy: Zenker's diverticulum]]
<br clear="left"/>
 
==Histopathological Findings: Esophagus; Zenker's diverticulum==
 
<youtube v=CEYU0Dq9n2s/>
 
==Treatment==
If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck [[surgery]] to resect the [[diverticulum]] and incise the [[cricopharyngeus]] muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling<ref>PMID 15453934 Endoscopic stapling of pharyngeal pouch, J Laryngol Otol. 2004 Aug;118(8):601-6</ref><ref>PMID 12782805 Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases, Laryngoscope. 2003 Jun;113(6):957-65</ref> (i.e. closing off the diverticulum via a stapler inserted through a tube in the mouth). This may be performed through a fibreoptic endoscope<ref>PMID 15966520 Fiberoptic endoscopic-assisted diverticulotomy: a novel technique for the management of Zenker's diverticulum, Ann Otol Rhinol Laryngol. 2005 May;114(5):347-51</ref>. Other non-surgical treatment modalities exist, such as endoscopic laser, which recent evidence suggests it less effective than stapling.<ref>PMID 16954989 The Endoscopic Management of Zenker Diverticulum: CO2 Laser versus Endoscopic Stapling, Laryngoscope. 2006 Sep;116(9):1608-11</ref>


==References ==
==Treatment==
{{Reflist|2}}
[[Zenker's diverticulum medical therapy|Medical Therapy]] | [[Zenker's diverticulum surgery|Surgery]] | [[Zenker's diverticulum primary prevention|Primary Prevention]]  | [[Zenker's diverticulum cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Zenker's diverticulum future or investigational therapies|Future or Investigational Therapies]]


==Other external links==
==Case Studies==
* [http://www.duke.edu/web/dumc_ohns/zenkers/index.html Duke University]
[[Zenker's diverticulum case study one|Case #1]]
* [http://www.entcolumbia.org/zenker.htm Columbia University]
* [http://www.ZenkersInfo.org ZenkersInfo.org]
* {{GPnotebook|389349395}}
* {{WhoNamedIt|synd|2461}}


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{{Gastroenterology}}
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Latest revision as of 14:21, 3 January 2018

Zenker's diverticulum
Source:Radiopaedia[1]

ICD-10 K22.5
ICD-9 530.6
DiseasesDB 31174
MeSH D016672

Zenker's diverticulum Microchapters

Home

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Zenker's diverticulum from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate editor-In-Chief: Ajay Gade MD[2]]

Synonyms and keywords: Hypopharyngeal diverticulum, pharyngoesophageal diverticulum

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Zenker's diverticulum from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Template:Gastroenterology de:Zenker-Divertikel it:Diverticolo di Zenker


Template:WikiDoc Sources

  1. "Zenker diverticulum | Radiology Case | Radiopaedia.org".