Zenker Diverticulum
Diverticulum
Meckel Diverticulum
Pharyngeal pouch (Zenker's diverticulum). (1/24)
Pharyngeal pouches occur most commonly in elderly patients (over 70 years) and typical symptoms include dysphagia, regurgitation, chronic cough, aspiration, and weight loss. The aetiology remains unknown but theories centre upon a structural or physiological abnormality of the cricopharyngeus. A diagnosis is easily established on barium studies. Treatment is surgical via an endoscopic or external cervical approach and should include a cricopharyngeal myotomy. Unfortunately pharyngeal pouch surgery has long been associated with significant morbidity, partly due to the surgery itself and also to the fact that the majority of patients are elderly and often have general medical problems. External approaches are associated with higher complication rates than endoscopic procedures. Recently, treatment by endoscopic stapling diverticulotomy has becoming increasingly popular as it has distinct advantages, although long term results are not yet available. The small risk of developing carcinoma within a pouch that is not excised remains a contentious issue and is an argument for long term follow up or treating the condition by external excision, particularly in younger patients. (+info)Incidentally found pharyngoesophageal diverticulum on ultrasonography. (2/24)
The pharyngoesophageal diverticulum in the lower part of the neck can be detected using neck ultrasonography. We present a case of pharyngoesophageal diverticulum mimicking a thyroid nodule, which was found incidentally by ultrasonography, and discuss its peculiar findings, which might be useful to diagnose pharyngoesophageal diverticulum and to prevent invasive procedures such as needle aspiration biopsy. (+info)Long-term follow-up of endoscopic stapled diverticulotomy. (3/24)
We report a consecutive series of 31 patients who underwent endoscopic stapled diverticulotomy. The patients' notes were reviewed retrospectively to gather data on their original admission and a postal survey was conducted to establish patient satisfaction, their ability to swallow and re-operation data. Three patients were lost to follow-up. Nine of the remaining 28 died at a median of 18 months. The remaining 21 were followed up for a median of 59 months. The data showed that, at 5 years, 94.4% of patients had an improvement in their swallowing, and 50% had an entirely normal swallow. In order to achieve this result, 19% of patients required a second procedure, and one patient (3.2%) required a third (open) procedure. Endoscopic stapled diverticulotomy has well-established, short-term advantages. This series shows that it has a good long-term outcome that is similar to established open techniques and probably better than other techniques of endoscopic diverticulotomy, i.e. diathermy or laser. (+info)A retrospective review of pharyngeal pouch surgery in 56 patients. (4/24)
We retrospectively reviewed 56 consecutive patients treated surgically for a pharyngeal pouch at our institution between 1989-1999 (10 years). Various surgical procedures were performed including endoscopic stapling (20), external excision (23), Dohlman's procedure (9), pouch inversion (3), cricopharyngeal myotomy only (3), and pouch suspension (1). There were 12 patients (18%) with complications and one mortality (2%). Four patients (7%) had a recurrence with 2 requiring further surgery. Over the latter 3 years, endoscopic stapling has emerged as the primary procedure for pharyngeal pouch surgery in our unit; with the advantages of an earlier commencement of diet and earlier hospital discharge. However, results were not as good as for external excisions. Furthermore, there were difficulties with 3 cases that commenced as endoscopic stapling procedures but had to he converted to external excisions due to inaccessibility in one case and iatrogenic perforations in two cases. As with any new technique, problems may occur and a learning curve has been appreciated in our unit. Surgeons must he prepared, with informed consent, to convert to an external approach should difficulties arise during endoscopic stapling. Elderly and frail patients who are at risk from a general anaesthetic may benefit from endoscopic stapling. External excision of pharyngeal pouches may be more appropriate in the young, the medically fit, and when malignancy is a concern. (+info)Current management in pharyngeal pouch surgery by UK otorhinolaryngologists. (5/24)
INTRODUCTION: Many surgical techniques have been described for the treatment of pharyngeal pouches but there is no single treatment of choice. The aim of this study was to determine current practice in pharyngeal pouch surgery by UK otolaryngologists. METHODS: A postal questionnaire was sent to all UK-based consultant members of the British Association of Otolaryngologists - Head and Neck Surgeons (BAO-HNS). RESULTS: Endoscopic stapling diverticulotomy is the most commonly performed procedure, performed by 89% of surgeons, followed by excision. Of those consultants that considered there to be a treatment of choice, 83% stated endoscopic stapling as their preference. Practices differ regarding the insertion of nasogastric tubes after endoscopic procedures and the need for postoperative barium studies. The length of in-patient stay tends to be short with 80% of surgeons discharging patients by day 2. CONCLUSIONS: Endoscopic stapling diverticulotomy is now the most commonly performed procedure for the management of pharyngeal pouches by UK otolaryngologists and is now considered by many to be the treatment of choice. (+info)Sonographic findings of Zenker diverticula. (6/24)
OBJECTIVE: The purpose of this study was to describe the sonographic findings of Zenker diverticula. METHODS: This study included 6 patients (age, 26-70 years; average, 55.3 years). Three cases were detected incidentally by thyroid sonograms, and 3 cases were transferred from other hospitals for aspiration of a thyroid nodule. All the sonograms and medical records were reviewed retrospectively. RESULTS: All 6 patients had no symptoms, and diverticula were incidentally detected by neck sonography. The masses were located on the posterolateral aspect of the left lobe in 5 patients and the right lobe in the remaining patient. All lesions were located in the upper and mid portions of the thyroid glands and showed echogenic foci similar to those of a microcalcification or an arc-shaped microcalcification. The sonographic findings of a Zenker diverticulum were seen as an isoechoic or a hypoechoic mass with internal or peripheral echogenic foci and a boundary hypoechoic zone at the posterior portion of the thyroid gland on sonography. All lesions appeared connected with the adjacent esophageal wall on sonography. In all cases, diagnoses were confirmed by esophagography. CONCLUSIONS: Zenker diverticula had several unique characteristics on sonography. We can, therefore, diagnose Zenker diverticula by careful thyroid sonography, avoiding unnecessary aspiration due to misdiagnosis of a Zenker diverticulum as a thyroid nodule. (+info)Ulcer in the basis of Zenker's diverticulum mimicking esophageal malignancy. (7/24)
Complications of Zenker's diverticulum are rare and include ulcer, bleeding and malignancy. Ulcer in the basis of diverticulum is a very rare complication and to date only four cases have been reported in the literature. Herein, we report a new case of ulcer in Zenker's diverticulum mimicking esophageal malignancy presumed to be due to aspirin and/or alcohol consumption. The exact diagnosis was troublesome and needed to perform diagnostic procedures repeatedly. The patient underwent external pharyngoesophageal diverticulectomy. We emphasize that endoscope should be withdrawn if any resistance is encountered during esophageal intubation-even with forward-viewing endoscope-especially when there is a Zenker's diverticulum suspicion and the patient receives ulcerogenic agents. Endoscopic examination should be performed prior to any definitive surgical procedure in all patients with Zenker's diverticulum. (+info)20 years experience in the management of Zenker's diverticulum in a third-level hospital. (8/24)
Zenker s diverticulum arises in the posterior wall of the pharynx, above the cricopharyngeal muscle, secondary to a functional cricopharyngeal disorder. We describe our experience with the management of Zenker s diverticulum from 1985 to this day in a third-level hospital. We review clinical data from 27 patients (78% males) with a mean age of 60.4 years. The most common clinical manifestations were dysphagia, regurgitation, syalorrhea, cough, and weight loss. All cases were diagnosed using an esophagogram. A diverticulectomy with cricopharingeal myotomy was performed in 74% of patients. Complications developed in 5 cases (21%), and the recurrence rate was 4% (1 of 3 cases, where myotomy was not performed). (+info)A Zenker diverticulum is a small, pouch-like structure that forms in the back of the throat (pharynx), specifically in the area called the hypopharynx. It's an acquired condition, which means it develops over time due to increased pressure in the pharyngeal muscles, leading to the formation of the diverticulum. This condition is more common in older adults and can cause difficulty swallowing (dysphagia), regurgitation of undigested food, halitosis (bad breath), and occasionally coughing or choking, especially when lying down. The diagnosis is typically made through a barium swallow X-ray study or an endoscopic examination. Treatment usually involves surgical intervention to remove the diverticulum and relieve symptoms.
A diverticulum is a small sac or pouch that forms as a result of a weakness in the wall of a hollow organ, such as the intestine. These sacs can become inflamed or infected, leading to conditions like diverticulitis. Diverticula are common in the large intestine, particularly in the colon, and are more likely to develop with age. They are usually asymptomatic but can cause symptoms such as abdominal pain, bloating, constipation, or diarrhea if they become inflamed or infected.
Meckel's diverticulum is a congenital condition in which a small pouch-like structure protrudes from the wall of the intestine, typically located on the lower portion of the small intestine, near the junction with the large intestine. It is a remnant of the omphalomesenteric duct, which is a vestigial structure that connects the fetal gut to the yolk sac during embryonic development.
Meckel's diverticulum is usually asymptomatic and goes unnoticed. However, in some cases, it can become inflamed or infected, leading to symptoms such as abdominal pain, nausea, vomiting, and blood in the stool. This condition is more common in males than females and is typically diagnosed in children under the age of 2. If left untreated, Meckel's diverticulum can lead to complications such as intestinal obstruction, perforation, or bleeding, which may require surgical intervention.
An esophageal diverticulum is a small pouch or sac that forms as a result of a protrusion or herniation of the inner lining (mucosa) of the esophagus through the outer layer of muscle in the wall of the esophagus. Esophageal diverticula can occur in any part of the esophagus, but they are most commonly found in the lower third of the esophagus, near the junction with the stomach.
Esophageal diverticula may be congenital (present at birth) or acquired (develop later in life). Acquired esophageal diverticula are often associated with underlying conditions such as esophageal motility disorders, strictures, or tumors that increase the pressure inside the esophagus and cause the mucosa to bulge out through weakened areas of the esophageal wall.
Symptoms of esophageal diverticula may include difficulty swallowing (dysphagia), regurgitation of undigested food, chest pain, heartburn, and recurrent respiratory infections due to aspiration of food or saliva into the lungs. Treatment options for esophageal diverticula depend on the size and location of the diverticulum, as well as the presence of any underlying conditions. Small asymptomatic diverticula may not require treatment, while larger symptomatic diverticula may be treated with surgical removal or endoscopic repair.