A Case of Zenker’s Diverticulum in a Patient with Tight Esophageal Peptic Stricture

Abstract

Zenker’s diverticulum (ZD) is a posterior Sac like outpouching of the hypopharyngeal mucosa and submucosa through Killian’s triangle, which is an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor muscle. ZD usually presents with swallowing difficulties, regurgitation of undigested food, choking, halitosis, weight loss, and respiratory symptoms due to chronic aspiration. Several esophageal pathologies have been reported in association with ZD. These include cervical esophageal webs, upper esophageal stenosis, and hiatus hernia. Herein, we report a case of ZD in association with severe gastroesophageal reflux disease and tight lower esophageal peptic stricture.

Keywords

Zenker’s diverticulum - peptic stricture - gastroesophageal reflux disease

Publikationsverlauf

Artikel online veröffentlicht:
30. September 2020

• References

• 1 Bizzotto A, Iacopini F, Landi R, Costamagna G. Zenker’s diverticulum: exploring treatment options. Acta Otorhinolaryngol Ital 2013; 33 (04) 219-229
• 2 Ludlow A. A case of obstructive deglutition from a preternatural dilatation of a bag formed in pharynx. Med Observation Inquiries 1767; 3: 85
• 3 Zenker FA, Van Ziemssen H. Krankheiten des oesophagus. In: Handbuch der specielen pathologie und therapie. Van Ziemssen H. ed. Leipzig: FC Vogel; 1877
• 4 van Overbeek JJM. Meditation on the pathogenesis of ­hypopharyngeal (Zenker’s) diverticulum and a report of endoscopic treatment in 545 patients. Ann Otol Rhinol Laryngol 1994; 103 (03) 178-185
• 5 Watemberg S, Landau O, Avrahami R. Zenker’s diverticulum: reappraisal. Am J Gastroenterol 1996; 91 (08) 1494-1498
• 6 Maran AGD, Wilson JA, Al Muhanna AH. Pharyngeal diverticula. Clin Otolaryngol Allied Sci 1986; 11 (04) 219-225
• 7 Siddiq MA, Sood S, Strachan D. Pharyngeal pouch (Zenker’s diverticulum). Postgrad Med J 2001; 77 (910) 506-511
• 8 Law R, Katzka DA, Baron TH. Zenker’s diverticulum. Clin ­Gastroenterol Hepatol 2014; 12 (11) 1773-1782, quiz e111–e112
• 9 Sutherland HD. Cricopharyngeal achalasia. J Thorac Cardiovasc Surg 1962; 43: 114-126
• 10 van Overbeek JJ. Pathogenesis and methods of treatment of Zenker’s diverticulum. Ann Otol Rhinol Laryngol 2003; 112 (07) 583-593
• 11 Barclay AE. Der normale schlingmechanisms. Acta Radiol 1932; 13: 91-110
• 12 Cook IJ, Gabb M, Panagopoulos V. et al. Pharyngeal (Zenker’s) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology 1992; 103 (04) 1229-1235
• 13 Mercer CD, Hill LD. Esophageal web associated with Zenker’s diverticulum: a possible cause of continuing dysphagia after diverticulectomy. Can J Surg 1985; 28 (04) 375-376
• 14 Low DE, Hill LD. Cervical esophageal web associated with ­Zenker’s diverticulum. Am J Surg 1988; 156 (01) 34-37
• 15 Skinner EF, Page G. Esophago-diverticulostomy for stenosis of upper esophagus associated with Zenker’s diverticulum. Am Surg 1958; 24 (11) 806-810
• 16 Ponzoli Jr VA. Zenker’s diverticulum: a review of pathogenesis and presentation of 25 cases. South Med J 1968; 61 (08) 817-821
• 17 Smiley TB, Caves PK, Porter DC. Relationship between posterior pharyngeal pouch and hiatus hernia. Thorax 1970; 25 (06) 725-731
• 18 Gage-White L. Incidence of Zenker’s diverticulum with hiatus hernia. Laryngoscope 1988; 98 (05) 527-530
• 19 Delahunty JE, Margulies SI, Alonso WA, Knudson DH. The relationship of reflux esophagitis to pharyngeal pouch (Zenker’s diverticulum) formation. Laryngoscope 1971; 81 (04) 570-577
• 20 Hunt PS, Connell AM, Smiley TB. The cricopharyngeal sphincter in gastric reflux. Gut 1970; 11 (04) 303-306
• 21 Sasaki CT, Ross DA, Hundal J. Association between Zenker diverticulum and gastroesophageal reflux disease: ­development of a working hypothesis. Am J Med 2003; 115 Suppl 3A 169S-171S
• 22 Feussner H, Siewert JR. Zenker’s diverticulum and reflux. Hepatogastroenterology 1992; 39 (02) 100-104
• 23 Negus VE. Pharyngeal diverticula; observations on their evolution and treatment. Br J Surg 1950; 38 (150) 129-146
• 24 Sayles M, Harrison L, McGlashan JA, Grant DG. Zenker’s diverticulum complicating achalasia: a ‘cup-and-spill’ oesophagus. Bmj Case Reports 2013; 2013: bcr2013200702
• 25 Jones B, Donner MW, Rubesin SE, Ravich WJ, Hendrix TR. Pharyngeal findings in 21 patients with achalasia of the esophagus. Dysphagia 1987; 2 (02) 87-92