Pharyngeal Pouch

Overview of a pharyngeal pouch.

A.K.A Zenker’s Diverticulum

 

  • Mucosal protrusion between the two parts of the inferior pharyngeal constrictor:
    • Thyropharyngeus muscle
    • Cricopharyngeus muscle
    • Weak area situated posteriorly
      • Killian’s dehiscence

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Pouch originates above cricopharyngeus muscle which is in spasm
    • Develops first posteriorly
    • Cannot expand in this direction
    • Moves laterally
      • More often left
  • Pouch eventually displaces oesophagus laterally
  • Pulsion diverticulum – forms as result of increased intraluminal pressure

 

Clinical features

  • More common in:
    • Men
    • The elderly
    • Dysphagia
    • Regurgitation of food collected in the pouch
      • Leads to a foetor
      • Late regurgitation may lead to aspiration pneumonia
      • Often a palpable swelling in the neck
      • Diagnosis confirmed by barium swallow

Treatment

  • Excision of pouch and posterior myotomy of cricopharyngeus muscle
  • Alternatively, division of wall between pouch and oesophagus using endosopic stapling (endoscopic diverticulotomy)
    • Leave pouch in situ
    • Avoid risk of fistula formation and leaks associated with open operation