c l i n i c a l f o l i o s : d i s c u s s i o n

Zenker's Diverticulum



Related narrative: Zenker's Diverticulum, Zenker's Diverticulum: Endoscopic Approach

Pharyngoesophageal diverticulum, more commonly refereed to as Zenker's diverticulum, represent the most common form (0.11% overall incidence) of false diverticulum of the esophagus. These lesions result from an increased pressure gradient in the proximal esophagus, which causes herniation of the mucosa through the overlying muscle layers just proximal to the cricopharyngeal muscle. The etiology of these lesions is related to mechanical incoordination coupled with muscle degeneration. Symptoms develop as the diverticulum enlarges and traps undigested food. Patients, usually age 50 to 80, present with halitosis, regurgitation, and aspiration. Repeated aspiration episodes can lead to pneumonia and lung abscesses. The diagnosis is made by history and barium swallow which demonstrates the diverticulum. Care should be taken when performing endoscopy for other reasons, as the diverticulum can be easily ruptured.

Patients with radiographic confirmation of the diverticulum should be treated surgically on an elective basis. A small diverticulum (less than 2 cm) may be treated by cricopharyngeal myotomy alone, while larger lesions require resection in addition to myotomy. Key points to the cricopharyngeal operative approach are summarized as follows:

1. Left neck incision along anterior border of the sternocleidomastoid.
2. Identification of the diverticulum between the inferior constrictor of the pharynx and the cricopharyngeal muscle.
3. Insertion of bougie dilator to help with dissection.
4. Myotomy made a distance of 4 cm caudal from the neck of the diverticulum.
5. Resection of the diverticulum if greater than 2 cm.
6. Placement of JP drain.

Postoperative course consists of barium swallow on the day after surgery, and removal of the drain if no leak is present. Diet is resumed and the patient is discharged home. If a small leak is present then the drain is left in place. Re-exploration is done if the leak is large. Long-term success is common with 93% of patients having good results and an overall morbidity of 3.6%.


Textbook of surgery: the biological basis of modern surgical practice.-15th ed. / [edited by] David C. Sabiston, Jr.; editor for basic surgical science, H. Kim Lyerly.

Current Surgical Therapy.-6th ed. / [edited by] John C. Cameron. 1998. S. Watemberg, O. Landau, and R. Avrahami. Zenker's Diverticulum: Reappraisal. American Journal of Gastroenterology 91(8): August 1996

This page was last modified on 26-Apr-2000.