Gastroenterology

Zenker Diverticulum song

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Zenker Diverticulum

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Key points in this song10

Zenker diverticulum is a false (pulsion) diverticulum — a posterior pharyngeal outpouching through Killian's triangle, located between the thyropharyngeus and cricopharyngeus muscles of the inferior pharyngeal constrictor.
The underlying mechanism is incomplete relaxation of the upper esophageal sphincter (cricopharyngeus muscle dysfunction), causing increased hypopharyngeal pressure and mucosal herniation.
Classic presentation: elderly male with progressive dysphagia, regurgitation of undigested food (hours after eating), halitosis, and a gurgling neck mass that may transiently enlarge with swallowing.
Patients are at high risk for aspiration pneumonia due to pooling of undigested food within the diverticulum, which can regurgitate silently during recumbency.
Barium esophagram (modified barium swallow) is the diagnostic test of choice — endoscopy is avoided initially due to perforation risk from inadvertent cannulation of the diverticulum.
Zenker diverticulum is NOT a true diverticulum — it lacks a muscularis propria layer, containing only mucosa and submucosa herniated through the posterior pharyngeal wall.
Classic presentation: elderly patient with dysphagia, regurgitation of old food, and bad breath — think Zenker diverticulum before achalasia or esophageal cancer.
Definitive treatment is surgical cricopharyngeal myotomy, often combined with diverticulectomy or diverticulopexy; endoscopic stapling (Dohlman procedure) is a less invasive alternative.
Zenker diverticulum is located in the hypopharynx — technically above the upper esophageal sphincter — distinguishing it from mid-esophageal (traction) and epiphrenic diverticula.
Complications include aspiration pneumonia, malnutrition, and rarely squamous cell carcinoma arising within the diverticulum — an important long-term association.