IS Case 195: Zenker diverticulum

Wade Hedegard, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

Patient is an 86-year-old female with dysphagia.

Upper GI barium examination demonstrated a posterior hypopharyngeal esophageal outpouching. A lateral view of the esophagus clearly demonstrated a barium-filled sac posterior to cervical esophagus.

A Zenker diverticulum is an outpouching from the posterior cervical esophagus with the neck opening above the cricopharyngeus muscle, near the C5-C6 level. It is a false diverticulum with only mucosa and submucosa present in the hernia sac. Zenker diverticula usually arise in elderly patients in their 70's and 80's, males more commonly than females. The prevalence is approximately 0.11% of people. Predisposing factors include any cause of increased esophageal intraluminal pressure, such as achalasia, esophageal spasm or presbyesophagus. Gastroesophageal reflux and a history of reflux esophagitis also contribute to the development of a Zenker diverticulum. Symptoms due to this abnormality include upper esophageal dysphagia, frequent regurgitation of undigested food and halitosis. Patients with a Zenker diverticulum are also at a higher risk for aspiration pneumonia. Rare complications include diverticulitis with fistula formation, perforation or carcinoma. Treatment varies depending on the size of the lesion. Small asymptomatic diverticula require no treatment, while symptomatic or large diverticula require surgical diverticulectomy or endoscopic repair. Associated esophageal motility disorders may be treated with a myotomy simultaneously.

Sydow BD, Levine MS, Rubesin SE, Laufer I. Radiographic findings and complications after surgical or endoscopic repair of Zenker's diverticulum in 16 patients. AJR Am J Roentgenol. 2001 Nov;177(5):1067-71. [PMID: 11641171]
Semenkovich JW, Balfe DM, Weyman PJ, Heiken JP, Lee JK. Barium pharyngography: comparison of single and double contrast. AJR Am J Roentgenol. 1985 Apr;144(4):715-20. [PMID: 3872027]