Zenker's diverticulum

Background

• An out-pouching of the pharyngeal mucosa and submucosa through the cricopharyngeus muscle
• Classified as false diverticulum in that it does not contain all layers of the intestinal wall, but only the mucosa and submucosa

Clinical Features

• Dysphagia
• Globus sensation
• Regurgitation of undigested food
• Halitosis

Differential Diagnosis

Dysphagia

• Oropharyngeal dysphagia
  • CVA
  • Parkinson's disease
  • Brain stem tumors
  • Degenerative disease - ALS, MS, Huntington's
  • Postinfectious - polio, syphilis
  • Peripheral neuropathy
  • Myasthenia gravis
  • Polymyositis, dermatomyositis
  • Muscular dystrophy
• Esophageal dysphagia
  • Achalasia
  • Diffuse esophageal spasm
  • Ingested foreign body
  • Esophageal web
  • Malignancy, mediastinal masses
  • Schatzki Ring
  • Scleroderma
  • Strictures - peptic, radiation, chemical, medication-induced
  • Vascular compression
  • Zenker's diverticulum

Evaluation

• Barium swallow
• Rule out emergent causes of symptoms

Management

• Often not treated, but surgery considered in some cases of particularly symptomatic diverticula

Disposition

• Discharge