|Classification and external resources|
In anatomy, Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, also hypopharyngeal diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a false diverticulum (not involving all layers of the esophageal wall).
Zenker's diverticulum mainly affects older adults.
Mechanisms and manifestations
In simple words, when there is excessive pressure within the lower pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter.
More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (variously known as Killian's triangle, Laimer's triangle, and the Killian-Laimer triangle). The result is an outpouching of the posterior pharyngeal wall, just above the oesophagus, specifically just above the cricopharyngeal muscle.
While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as dysphagia (difficulty swallowing), and sense of a lump in the neck; moreover, it may fill up with food, causing regurgitation (reappearance of ingested food in the mouth), cough (as some food may be regurgitated into the airways), halitosis (smelly breath, as stagnant food is digested by microrganisms), potential infection of the pharyngeal areas due to food stuck, and involuntary gurgling noises when swallowing. It rarely, if ever, causes any pain.
Cervical webs are seen associated in 50% of patients with this condition.
A simple barium swallow will normally reveal the diverticulum. upper GI endoscopy also shows the diverticulum. sipping contrast and taking CT , oral contrast with CT neck also gives a definite diagnosis.
If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling (i.e. diverticulotomy with staples ). This may be performed through a diverticuloscope. other novels method include fibreoptic diverticular repair. 
Other non-surgical treatment modalities exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.
- synd/2461 at Who Named It?
- F. A. Zenker and Hugo Wilhelm von Ziemssen. Krankheiten des Oesophagus. Leipzig, 1867.
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- Altman JI, Genden EM, Moche J (May 2005). "Fiberoptic endoscopic-assisted diverticulotomy: a novel technique for the management of Zenker's diverticulum". Ann. Otol. Rhinol. Laryngol. 114 (5): 347–51. PMID 15966520.
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