What is the most probable diagnosis?
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Zenker Diverticulum
Case Discussion:
Zenker diverticulm which is also known as a pharyngeal pouch, is the puslsion of the mucosa of the pharynx just above the upper sphincter of the esophagus. ( just above the cricophrangeal muscle).
It is a false diverticulum as it does not involve all the layers of the esophageal wall.
It is a rare lesion and is commonly seen in elderly people.
Etiology: A complete understanding of the etiology of Zenker diverticulum is still not known. A few hypothesis include:
- incomplete cricophrangeal muscle relaxation.
- elevated resting tone of the entire upper esophageal sphincter.
- loss of cricopharangeal muscle elasticity.
- focal spastic damage to the cricopharangeal mucsle.
- cricopharangeal muscle spasm secondary to long standing GERD.
Clinical Features: include:
- Dysphagia i.e difficulty in swallowing and feeling of a lump in the throat.
- Regurgitation of undigested food, hours after eating.
- Feeling of food sticky in the throat.
- Halitosis (bad smelly breath as stagnant food is digested by microorganisms).
- Cough after eating due to regurgitation of food into the airways.
- Unexplained weight loss.
Diagnosis: The simple barium swallow will normally reveal the diverticulum . An upper endoscopy can also help in diagnosis and show the diverticulum.
Treatment: Zenker Diverticulum requires any treatment intervention only if it is producing symptoms. Some surgeons suggest to operate early as it tends to increase in size with time.
Small lesions are satisfactorily treated with cricophrangeaus myotomy with or without invagination procedure.
Now in some patients endoscopic laser may be helpful without the need for surgery.
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