Question
| A. | Achalasia cardia |
| B. |
Tracheoesophageal fistula |
| C. |
Zenker’s diverticulum |
| D. |
Diabetic gastropathy |
|
Correct Answer � C Explanation |
 |
Ans. is c i.e. Zenker’s Diverticulum
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In Zenker’s diverticulum patients present with intermittent dysphagia + regurgitation of food + foul smelling breath.
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Later on the dysphagia becomes progressive.
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In case of achalasia cardia patients present with dysphagia to liquids initially which later on progresses to involve solids also.
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In trachea esophageal fistula patients present with cough during meals causing difficulty in eating.
ZENKER’S DIVERTICULUM (PHARYNGEAL POUCH)
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It is a posterior pharyngeal pulsion diverticulum through the Killian’s dehiscence (area of weakness also called gateway of tears), between the thyropharyngeus and cricopharyngeus parts of inferior constrictor muscle.
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There is incoordination between the descending peristaltic wave and cricopharyngeus muscle at the upper esophageal sphincter leading to abnormally high intraluminal pressure and mucosal herniation through the weak area of Killian’s dehiscence.
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Usually seen in elderly above 60 years.
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M/c symptom is dysphagia;initially intermittent which becomes progressive later on.
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It is associated with regurgitations of food and cough.
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Patients may experience halitosis and regurgling sounds in the neck.
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The gurgling sensation palpation of the neck is known as Boyce sign.
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Diagnosis is by Barium swallow + videofluoroscopy.
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Malignancy can develop in 0.5-1% cases
Treatment :
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Endoscopic stapling of the diverticulo esophageal septum (Earlier excision of diverticulum with cricopharyngeal myotomy was considered to be the treatment of choice.
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In patient not fit for major procedures, Dohlman’s surgery diverticulotomy may suffice.
NOTE :
Zenker’s Diverticulum is not a true diverticulum.
