When a muscle is weakened or split, the tissue nearby can sometimes slide into the space created, causing the formation of a pouch or indentation. The word diverticulum (the plural of which is diverticula) refers to a pouch, sac, or indentation created by the herniation (weakening or splitting) of a muscle wall. Zenker’s diverticula (ZD) are pouches or pockets that form in the pharynx, the passage of the upper throat that connects to the trachea and esophagus. They are typically found on the left side of the neck because the esophagus’ slightly curved shape creates a space there.The direct cause of ZD is most often the splitting or weakening of muscles in an area of the pharynx called the Killian triangle (these splits or weak spots are possible in other areas of the pharynx, too, but not as likely). It is not known what exactly causes the split in the first place, though doctors speculate that abnormal muscular movements during swallowing, muscle spasms (caused, for example, by gastroesophageal reflux disease), inability of the muscles to completely relax, or underlying abnormalities in the upper esophageal sphincter (the “valve” that opens and closes the path to the stomach) may be contributing factors.
ZD occurs in men more frequently than women, tends to effect people of Northern European heritage more often than people from other backgrounds, and almost always occurs in older patients.
Depending on how a particular ZD is shaped, food can become trapped or lodged there, potentially causing a number of problems. Symptoms of ZD can include difficulty swallowing, bad breath due to trapped food, regurgitation of food long after eating, discomfort in the throat, gurgling noises coming from the throat or neck, and – most dangerous – possible aspiration of food or liquid into the airways, which can lead to lung damage, irritation, or infection. Another risk, depending on size and positioning of ZD, is obstruction of the esophagus (the tube leading down to the stomach from the throat) or the trachea (the “breathing tube”).
The disorder is diagnosed by endoscopy, which involves the use of a telescope-like tube to view the pharynx, and also by tests that monitor swallowing function. The most dependable means of diagnosis is a test called a barium esophagography, during which patients swallow a liquid containing radioactive barium and then x-ray equipment is used to detect whether the liquid has flowed through the area abnormally, indicating areas of liquid pooling.
If in the case of a very small ZD, doctors sometimes opt to do nothing rather than subject a patient to surgical correction. But if difficulty swallowing or other symptoms are severe enough (and frequently they are), surgery may become necessary. The types of surgery performed to repair ZD include transcervical surgery, which involves the use of a lateral neck incision, an endoscopic procedure called the Dohlman procedure, which creates a path from the ZD back into the esophagus using an endoscope and a laser, or endoscopic staple diverticulotomy, during which the ZD is closed with staples.Since the symptoms of ZD are similar to those of a wide variety of GI tract disorders, it is important to report difficulty swallowing or other abnormal sensations in the throat that last for more than a short time or recur repeatedly to a health care professional. This will increase the likelihood that any necessary treatments or procedures are performed before dangerous symptoms and connected disorders surface.
