(See also Overview of Esophageal and Swallowing Disorders.)
Small diverticula in the upper esophagus were noted incidentally in this patient during an evaluation for nausea and vomiting.
Zenker diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle. In this image, the diverticulum is on the left, next to the triangular opening of the trachea formed by the vocal cords.
Traction diverticula are midesophageal outpouchings of mucosa and submucosa caused by motility disorders or by traction resulting from mediastinal processes. In this image, the diverticulum is to the right of the esophagus and gives the appearance of a double lumen.
There are several types of esophageal diverticula, each of different origin:
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Zenker (pharyngeal) diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle, probably resulting from an incoordination between pharyngeal propulsion and cricopharyngeal relaxation.
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Midesophageal (traction) diverticula are caused by traction resulting from mediastinal inflammatory lesions or, secondarily, by esophageal motility disorders.
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Epiphrenic diverticula occur just above the diaphragm and usually accompany a motility disorder (eg, achalasia, diffuse esophageal spasm).
Symptoms and Signs
A Zenker diverticulum fills with food that might be regurgitated when the patient bends or lies down. Aspiration pneumonitis may result if regurgitation is nocturnal. Rarely, the pouch becomes large, causing dysphagia and sometimes a palpable neck mass.
Traction and epiphrenic diverticula are rarely symptomatic, although their underlying cause may be.
Diagnosis
Treatment
Specific treatment is usually not required, although resection is occasionally necessary for large or symptomatic diverticula. Diverticula associated with motility disorders require treatment of the primary disorder. For example, case reports suggest doing a cricopharyngeal myotomy when resecting a Zenker diverticulum. There are also emerging endoscopic treatment options for diverticulectomy.
