A Zenker diverticulum is a pouch of the throat lining that pushes out just above the upper esophageal sphincter, through a weak spot in the back wall of the pharynx. It is most common in older adults and traps food, which causes swallowing problems and aspiration.
Key symptoms
- Trouble swallowing, mostly at the start of a swallow
- Regurgitation of undigested food hours after eating
- Bad breath
- Cough, gurgling in the neck or a hoarse voice
- Weight loss
What you find on exam
- Usually normal; sometimes a soft swelling on the left side of the neck
- Gurgling sound when pressing on the neck
- Weight and nutrition status
- Lung exam for signs of aspiration pneumonia
Tests
- Barium swallow: the key test to show the pouch
- Endoscopy with care, because the pouch can be perforated
- Chest X-ray if aspiration is suspected
- Swallow study to assess aspiration risk
Treatment basics
- Watchful waiting for small pouches without symptoms
- Endoscopic division of the wall between the pouch and the esophagus
- Open surgery: cricopharyngeal myotomy with removal or suspension of the pouch
- Soft diet and aspiration precautions before repair
Red flags
- Aspiration pneumonia
- Marked weight loss or dehydration
- Neck or chest pain and fever after endoscopy (perforation)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.