PHARYNGEAL POUCH

PHARYNGEAL POUCH


                                PHARYNGEAL POUCH

  • Pharyngeal pouch is the protusion of pharyngeal mucosa through a weak area in the posterior pharyngeal wall as Killian’s dehiscence.
  • Killian’s dehiscence is a potential weak area of weakness in between 2 parts of the inferior constrictor muscle-

a) Upper oblique fibres (thyropharyngeus)

b) Lower horizontal fibres (cricopharyngeus)

  

ETIOLOGY-

  • Increase pharyngeal pressure

 

CLINICAL FEATURE-

  • Seen in elderly males.
  • Difficulty in swallowing due to presence of small diverticulum.
  • As diverticulum enlarges in size regurgitation of undigested food long time after meal occurs.
  • Feeling of tightness in throuat and coughing.
  • Recurrent chest infection due to aspiration from pouch.
  • In last stage, gurgling noise in the neck is heard while swallowing.
  • Visible swelling in the posterior triangle of neck (sternocleidomastoid muscle) below level of thyroid cartilage.
  • Swelling is smooth, soft with ill defined margins.

  

INVESTIGATIONS-

  • Reduced on pressure and is non- transilluminant.
  • Barium swallow- thin barium swallow outlines pharynx, pouch and upper oesophagus.
  • Flexible endoscopy- shares opening of pouch.

  

TREATMENT-

  • Very old patient- conservative treatment
  • Late cases- excision of pouch
  • Cricopharyngeal myotomy relaxes sphincter.
  • Recent, endoscopic stapling technique is used

Exam Important

  • Pharyngeal pouch is the protusion of pharyngeal mucosa through a weak area in the posterior pharyngeal wall as Killian’s dehiscence.
  • Killian’s dehiscence is a potential weak area of weakness in between 2 parts of the inferior constrictor muscle-

a) Upper oblique fibres (thyropharyngeus)

b) Lower horizontal fibres (cricopharyngeus)

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