Pharyngeal Pouch (Zenker’s diverticulum)

• Rare- affects 1 in 100000 people, most commonly in middle-old age (>60) and in men (5:1)
• Occurs most commonly as a result of in-coordination of swallowing within the pharynx, most likely due to upper oesophageal sphincter dysfunction
  • this leads to herniation of the oesophagus through the cricopharygeus muscle and formation of a pouch
• Most patients are asymptomatic/minimally symptomatic
  • Dysphagia and regurgitation are the most common symptoms (95%)- patient often feels like food is getting lodged in the throat and food can be regurgitated, particularly on lying down
  • Halitosis is also common, as food can get trapped there
  • Chronic cough, aspiration pneumonia or unexplained weight loss can also feature
    • As such, cancer and strictures cannot be ruled out
• Barium swallow is preferred over endoscopy as this may perforate the pouch
  • Nasopharyngoscopy may show salivary pooling in the piriform fossa
• In patients with troublesome symptoms, surgical myotomy (diverticulotomy) +/- resection (diverticulectomy) can be performed
  • Endoscopic procedures may also be performed for small pouches where there is the clinical expertise