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