Zenker Diverticulum in a 69-Year-Old Man

For 8 months, a 69-year-old man had dysphagia, throat irritation, and a recurrent cough. He also complained of a bulge on the left side of the neck that decreased in size when pressed.

A barium esophagography and fluoroscopic examination showed a Zenker diverticulum. Drs Alexander K. C. Leung and Justine H. S. Fong of Calgary, Alberta, report that a Zenker diverticulum occurs posterolaterally between the lower border of the inferior pharyngeal constrictor and the upper border of the cricopharyngeal muscles. The disorder primarily affects older persons.

A Zenker diverticulum that is large and filled with food can compress the esophagus and cause dysphagia. Saliva and food particles that are retained in the pouch may be either aspirated or regurgitated and can provoke postprandial throat clearing. Halitosis is often associated with this condition.

In patients who have a Zenker diverticulum, nasogastric intubation and endoscopy need to be performed with extreme care because these procedures may perforate the diverticulum. Medical treatment usually is not helpful for this condition. Diverticulectomy or diverticulopexy with coincident section of the circopharyngeus muscle may be necessary.

This patient had an uneventful recovery after diverticulectomy.