Zenker Diverticulum
A 25-year-old medical student comes
to seek your
help because he thinks he “has
bad breath.” This past weekend,
a most disturbing event occurred
while he was watching a football game:
He coughed up the chicken
teriyaki he ate
2 days earlier. He claims to brush
his teeth every
night. The physical examination is normal.
What is the next
step in the
evaluation of this
patient?
Pathogenesis. Zenker diverticulum is the outpocketing of the posterior
pharyngeal constrictor muscles at the
back of the pharynx.
Clinical Presentation. This is generally a very slowly developing problem that occurs
in older patients. These
patients have bad breath and difficulty initiating swallowing because it is
such a proximal lesion.
Patients also complain
of having to repeatedly clear
their throats and waking
up with undigested, regurgitated food on their pillow. This is particularly
unpleasant because the food was usually eaten several days ago.
Diagnosis. The diagnosis is made on barium studies.
Treatment. Endoscopy and the placement of nasogastric tubes
are contraindicated because
of the risk of developing perforation of the pharynx.
Patients with Zenker diverticulum are treated with surgical resection.
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