Zenker's diverticulum is an outpouching arising in the upper esophagus.


Location: posterior hypopharynx-esophagus proximal to the cricopharyngeus


Mechanism: increased pressure in the hypopharynx during swallowed due to impaired opening of the upper esophageal sphincter (UES) secondary to fibrosis of the cricopharyngeus.


Clinical findings:

(1) males predominate

(2) throat irritation

(3) excessive mucus in the throat

(4) dysphagia localized to the throat

(5) gurgling sounds when swallowing

(6) regurgitation of liquids and/or decomposing food

(7) bad breath

(8) chronic coughing

(9) aspiration pneumonia


Findings on imaging studies:

(1) air fluid level in a lateral X-ray of the neck

(2) collection of barium posterior to the esophagus seen on barium swallow

(3) CT scan or MRI should be able to demonstrate the defect


Endoscopy is hazardous because of the risk of perforation.


A late complication is development of a carcinoma within the diverticulum.


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