A patient presented with regurgitation of food while lying down.Anterior and Lateral view of Barium Swallow is shown in the image.True regarding this condition is:
A. Traction type
B. Pulsion Type
C. True Diverticula
Ans:B. Pulsion Type.
Zenker’s Diverticulum is shown in the image.
Image “A” depicts the frontal view of a large barium-filled sac (Z) below the level of the hypopharynx. Image “B” is a lateral view depicting a large Zenker’s diverticula (Z) in the posterior cervical esophagus.
- Esophageal diverticula are classified by location in the esophagus. Upper (pharyngoesophageal, Killian-Jamieson, or Zenker), middle, or lower (epiphrenic).
- Diverticula also may be classified on the basis of histopathology. True diverticula contain all layers of the intestinal tract wall. False diverticula, also known as pseudodiverticula, occur when herniation of mucosa and submucosa through a defect in the muscular wall occurs (eg, Zenker diverticulum). A special type of pseudodiverticula, believed to represent dilated excretory ducts of esophageal submucosal glands, is observed in the condition esophageal intramural pseudodiverticulosis.
- Finally, acquired diverticula of the esophagus and hypopharynx also may be classified according to their pathogenesis as pulsion diverticula or traction diverticula. Pulsion diverticula form as a result of high intraluminal pressures against weaknesses in the GI tract wall. Zenker diverticulum occurs due to increased pressure in the oropharynx during swallowing against a closed upper esophageal sphincter.
- In contrast, traction diverticula occur as a consequence of pulling forces on the outside of the esophagus from an adjacent inflammatory process (eg, involvement of inflamed mediastinal lymph nodes in tuberculosis or histoplasmosis).
- Zenker’s diverticula or posterior hypopharyngeal diverticula are of the pulsion type. They are acquired lesions where mucosa herniates through an area of weakness around the cricopharyngeus muscle. Premature contraction or muscle incoordination of the cricopharyngeus muscle produces increased intraluminal pressure. This phenomenon is also known as Killian’s dehiscence. Zenker’s diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass.