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Tuesday, December 29, 2015

Zenker Diverticulum

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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