Materiały źródłowe

• #1 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,1.html

  Zenkers diverticulum occurrence is the consequence of esophageal mucosa membrane weakening with coexisting increase in UES tension. […] The increase in pressure during ingesta swallowing pushes esophageal tissue layers outside the esophagus to the mediastinum retropharyngeal space, forming a pouch with gates limited by muscles. […] Increase in pressure of the cricopharyngeal muscle results in decreased UES relaxation and subsequent further increase in pressure within the sphincter. […] The described mechanism results in the creation of an alternative route for ingesta. […] Individual susceptibility to diverticula occurrence is caused by fibrosis and histologically described inflammation within Killians triangle muscles fibers. […] The muscle dysfunction may be the consequence of diseases causing esophagus contraction, e.g. achalasia.

• #2 Zenker’s diverticulum – UpToDate

  https://www.uptodate.com/contents/zenkers-diverticulum

  Zenker’s diverticulum (ZD) is a sac-like outpouching of the mucosa and submucosa through Killian’s triangle, an area of muscular weakness between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor (ie, thyropharyngeus) muscle. […] This topic review will focus on clinical issues surrounding ZD.

• #3 Zenker Diverticulum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/836858-overview

  The pathologic process in Zenker diverticulum involves herniation of the esophageal mucosa posteriorly between the cricopharyngeal (CP) muscle and the inferior pharyngeal constrictor muscles. Therefore, by strict definition, a Zenker diverticulum is a false diverticulum. The retention of food elements and secretions within the lesions pouch frequently leads to halitosis, regurgitation, aspiration, and dysphagia in patients. […] Although Zenker proposed that a pulsion mechanism affects the pharyngeal mucosa above the CP muscle, no consensus exists regarding a unifying concept of the cause of Zenker diverticula. The specific abnormality of the CP muscle has not been elucidated. Hypothetical abnormalities include the following: […] It is hypothesized that abnormal muscle activity in the cricopharyngeus results in a discoordination of the swallowing mechanism, which, when coupled with increased intraluminal pressure on the mucosa of the pharynx, results in the slow, progressive distention of the mucosa. As the weakest portion of this area is located posteriorly, this becomes the location of the pulsion diverticulum formation. […] Zenker diverticula extend into the left neck 90% of the time. This is likely due to the slight convexity of the cervical esophagus to the left side and to the more laterally positioned carotid artery on the left side, creating a potential space for the sac.

• #4 Zenker’s diverticulum – Wikipedia

  https://en.wikipedia.org/wiki/Zenker%27s_diverticulum

  A Zenker’s diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a pseudo diverticulum or false diverticulum (only involving the mucosa and submucosa of the esophageal wall, not the adventitia), also known as a pulsion diverticulum. […] While traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker’s diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (known as Killian’s triangle, located superior to the cricopharyngeus muscle and inferior to the thyropharyngeus muscle). The result is an outpouching of the posterior pharyngeal wall, just above the esophagus.

• #5 Zenker’s diverticulum in an 85-year-old Ugandan man | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01914-2

  Zenkers diverticulum (ZD) is an uncommon disorder due to an outpouching of tissue through the Killian triangle that is thought to be caused by dysfunction of the cricopharyngeal muscle. […] The most common pathogenesis relates to increased intraluminal pressure leading to an outpouching in an area of relative wall weakness when compared with surrounding tissues. […] The acquired area of weakness is known as Killian triangle or Killians dehiscence which is in the hypopharynx between two strong muscles—the inferior pharyngeal constrictor and cricopharyngeus muscles. […] A continuous intraluminal pressure in this relative area of weakness leads to an outpouching and is the major pathogenesis of this entity. […] ZD are in the proximal esophagus and are pulsion diverticula.

• #6 Zenker’s Diverticulum

  https://www.otoscape.com/eponyms/zenker-s-diverticulum.html

  With a Zenkers diverticulum, increased intraluminal pressure is thought to arise due to problems with complete relaxation or opening of the cricopharyngeus. […] This increased pulsion pressure results in herniation of the esophageal mucosa and submucosa through an area of weakness called Killians Triangle. […] The failure of coordinated relaxation or expansion of the cricopharyngeus is called cricopharyngeus muscle dysfunction (CPD), which can be viewed as a gradient of disease that can eventually give rise to a Zenkers diverticulum.

• #7 Zenker’s Diverticulum | Mount Sinai – New York

  https://www.mountsinai.org/locations/grabscheid-voice-swallowing-center/conditions/zenkers-diverticulum

  A Zenker’s diverticulum is an outpouching that occurs at the junction of the lower part of the throat and the upper portion of the esophagus. The pouch forms because the muscle that divides the throat from the esophagus, the cricopharyngeal (CP) muscle, fails to relax during swallowing. […] When we swallow, milliseconds after the throat or pharyngeal muscles contract, the brain sends a signal to the CP muscle to relax and allow the food to go from the throat into the esophagus. […] If the CP muscle at the top of the esophagus does not relax completely or quickly enough, the food that is being swallowed is pushed against the top of the esophagus at the CP muscle and the weak area in Killian’s triangle is pushed out. Eventually a pouch, a Zenker’s diverticulum, can form. […] Since the main reason the diverticulum forms is failure of relaxation of the CP muscle, surgeons have found that surgical intervention is most effective when it targets cutting the CP muscle.

• #8 Zenker’s Diverticulum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/zenkers-diverticulum

  In Zenkers diverticulum, you have a pouch in the back of your throat. The pouch makes it hard for you to swallow food. Zenkers diverticulum typically affects people ages 70 to 90 and develops over time. You may have the condition for many years before you have symptoms. Healthcare providers treat the condition with surgery. […] A Zenkers diverticulum is an issue that affects your throat (pharynx). Its a pouch that forms at the bottom of your throat where your throat connects to your esophagus. The pouch traps food, making it hard for you to swallow. Zenkers diverticulum typically affects people aged 70 to 90. You may have this condition for years before you develop noticeable symptoms, and it doesnt go away on its own. Healthcare providers treat Zenkers diverticulum with surgery. […] Researchers dont know the exact cause but think issues with your cricopharyngeus muscle are to blame. This muscle is at the top of your esophagus. It opens (relaxes) to let food in and then closes. When you swallow food, powerful muscles in your throat push food down toward your cricopharyngeus muscle. When this muscle doesnt relax as it should, food gets caught in a muscular squeeze play that puts pressure on your pharynx wall. Over time, the pressure pushes tissue through the wall to make a pouch.

• #9 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,1.html

  Zenkers diverticulum occurrence is the consequence of esophageal mucosa membrane weakening with coexisting increase in UES tension. […] The increase in pressure during ingesta swallowing pushes esophageal tissue layers outside the esophagus to the mediastinum retropharyngeal space, forming a pouch with gates limited by muscles. […] Increase in pressure of the cricopharyngeal muscle results in decreased UES relaxation and subsequent further increase in pressure within the sphincter. […] The described mechanism results in the creation of an alternative route for ingesta. […] Individual susceptibility to diverticula occurrence is caused by fibrosis and histologically described inflammation within Killians triangle muscles fibers. […] The muscle dysfunction may be the consequence of diseases causing esophagus contraction, e.g. achalasia.

• #10 Pathology and Treatment of Zenker Diverticulum | Basicmedical Key

  https://basicmedicalkey.com/pathology-and-treatment-of-zenker-diverticulum/

  Zenker diverticulum was initially described by Abraham Ludlow in 1769 when he discovered the pathology during the autopsy of a man who had died from obstructed deglutition. […] This pharyngoesophageal diverticulum was given its eponym after Dr. Friedrich Albert von Zenker who described the pathology in great detail nearly a century later, including the pathophysiologic postulate that it arose as a pulsion diverticulum secondary to high hypopharyngeal pressures during swallowing. […] The pathophysiology of Zenker diverticulum can be observed with manometry. Initial investigation by Ellis in 1969 suggested a discoordination between the pharyngeal and cricopharyngeal contractions—specifically, premature cessation of relaxation of the upper esophageal sphincter, preventing the oral bolus to transit normally into the esophagus.

• #11 Pathology and Treatment of Zenker Diverticulum | Basicmedical Key

  https://basicmedicalkey.com/pathology-and-treatment-of-zenker-diverticulum/

  This results in abnormally persistent hypopharyngeal increased pressures against a closed upper esophageal sphincter, which the authors suggested may explain the development of the pulsion diverticulum. […] Subsequent manometric studies by Cook and colleagues in 1992 have refined this understanding, as they demonstrated increased hypopharyngeal pressures during the transit of the oral bolus and the opening of the upper esophageal sphincter in patients with Zenker diverticulum, but no discoordination of relaxation and contraction of the sphincter. […] The constrictive physiology of the cricopharyngeus muscle, which resulted in this increased resistance to bolus flow, was substantiated in the publication by that same group of a histologic study of the structural abnormalities of the muscle in patients with Zenker diverticulum. […] Other researchers have corroborated abnormal histologic findings in the cricopharyngeus muscle of Zenker diverticula patients, and aberrant innervation of the muscle is one proposed theory of the development of these structural abnormalities.

• #12 A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome | Oyama | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2311/1721

  Esophageal diverticula are rare, and are observed in less than 1% of upper gastrointestinal X-ray images. Among esophageal diverticula, Zenkers diverticulum (ZD) is commonly observed as a posterior pharyngoesophageal pouch having characteristics of a pseudodiverticulum and consisting of only mucosal and submucosal tissue, and is formed by pulsion forces in an area with relative wall weakness between the oblique fibers of the inferior pharyngeal constrictor and the horizontal fibers of the cricopharyngeus (CP) muscles. […] The most widely accepted mechanism for the development of ZD is a functional disturbance of the hypopharynx, including increased resting pressure of the UES, lack of sufficient relaxation, and lack of coordination between the hypopharynx and the UES. Patients with ZD may show dysfunction of the UES opening, replacement of the CP muscle fibers by fibrous adipose tissue, or a significant increase of the collagen to elastin ratio, leading to increased hypopharyngeal pressure due to decreased compliance of these muscles. Spastic condition of the CP muscle may also contribute to the onset of ZD.

• #13 Endo-Sketch

  https://www.healio.com/news/gastroenterology/20220406/video-whats-in-a-name-the-pathologist-behind-zenkers-diverticulum

  Zenkers diverticulum which is essentially a pseudodiverticulum is characterized by bulging of the mucosa, possibly due to uncoordinated swallowing, impaired relaxation and spasm of the upper esophageal sphincter. […] Although Zenker carefully described clinical features of the diverticulum in the book, he actually was known more for his discovery in 1860 of the pathogenesis of the parasitic disease trichinellosis and for identifying pork as the source of human infection.

• #14 A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome | Oyama | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2311/1721

  Esophageal diverticula are rare, and are observed in less than 1% of upper gastrointestinal X-ray images. Among esophageal diverticula, Zenkers diverticulum (ZD) is commonly observed as a posterior pharyngoesophageal pouch having characteristics of a pseudodiverticulum and consisting of only mucosal and submucosal tissue, and is formed by pulsion forces in an area with relative wall weakness between the oblique fibers of the inferior pharyngeal constrictor and the horizontal fibers of the cricopharyngeus (CP) muscles. […] The most widely accepted mechanism for the development of ZD is a functional disturbance of the hypopharynx, including increased resting pressure of the UES, lack of sufficient relaxation, and lack of coordination between the hypopharynx and the UES. Patients with ZD may show dysfunction of the UES opening, replacement of the CP muscle fibers by fibrous adipose tissue, or a significant increase of the collagen to elastin ratio, leading to increased hypopharyngeal pressure due to decreased compliance of these muscles. Spastic condition of the CP muscle may also contribute to the onset of ZD.

• #15 1.44: Surgery for Pharyngeal Pouch / Zenker’s Diverticulum – Medicine LibreTexts

  https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Atlas_of_Otolaryngology_Head_and_Neck_Operative_Surgery/01%3A_Head_and_Neck/1.44%3A_Surgery_for_Pharyngeal_Pouch___Zenker’s_Diverticulum

  Zenker, a German pathologist, first reported 27 hypopharyngeal pulsion diverticula in 1878. In 1907, Killian described the triangular dehiscence between the cricopharyngeus and inferior constrictor muscles that is the anatomic site of formation of Zenkers Diverticula. […] However, it was Zenker who correctly described it as a pulsing diverticulum and put earlier theories to rest. Since that time most authors agree that anatomic predisposition plays a central role in the pathogenesis, though the exact aetiology is still a subject of debate. […] It is now widely accepted that dysfunction of the cricopharyngeus muscle plays a central aetiological role. High intraluminal pressures at the level of Killians triangle result in herniation of esophageal mucosa and submucosa through this area of inherent muscular weakness.

• #16 Zenker’s diverticulum – WikEM

  https://wikem.org/wiki/Zenker%27s_diverticulum

  An out-pouching of the pharyngeal mucosa and submucosa through the cricopharyngeus muscle. […] Classified as false diverticulum in that it does not contain all layers of the intestinal wall, but only the mucosa and submucosa. […] Often not treated, but surgery considered in some cases of particularly symptomatic diverticula.

• #17 Zenker’s diverticulum – Wikipedia

  https://en.wikipedia.org/wiki/Zenker%27s_diverticulum

  A Zenker’s diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a pseudo diverticulum or false diverticulum (only involving the mucosa and submucosa of the esophageal wall, not the adventitia), also known as a pulsion diverticulum. […] While traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker’s diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (known as Killian’s triangle, located superior to the cricopharyngeus muscle and inferior to the thyropharyngeus muscle). The result is an outpouching of the posterior pharyngeal wall, just above the esophagus.

• #18

  https://step1.medbullets.com/gastrointestinal/110048/zenker-diverticulum

  Killian triangle is a natural area of weakness within the muscular wall of the esophagus and is more common in men […] thought to result from chronic increased pressure on the weakened area due to either […] high intrabolus pressures during swallowing […] resistance to swallowing due to abnormalities of the upper esophageal sphincter.

• #19 Zenkers Diverticulum Pathogenesis and Clinical Findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/zenkers-diverticulum-pathogenesis-and-clinical-findings/zenkers-diverticulum-2/

  Zenkers Diverticulum: Pathogenesis and Clinical Findings […] the pathogenesis of Zenkers Diverticulum is multifactorial, but this mechanism is thought to be a significant contributor […] Herniation of the esophagus at a weak point between the inferior pharyngeal constrictor muscle and the cricopharyngeal muscle (Killians triangle) […] Zenkers Diverticulum Acquired mucosal herniation between the horizontal and oblique fibers of the cricopharyngeus muscle […] Inability of the the upper esophageal sphincter to completely open […] Esophageal Obstruction […] Diverticulum compresses recurrent laryngeal nerve […] Impaired innervation to the intrinsic muscles of the larynx and other contributing factors.

• #20 1.44: Surgery for Pharyngeal Pouch / Zenker’s Diverticulum – Medicine LibreTexts

  https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Atlas_of_Otolaryngology_Head_and_Neck_Operative_Surgery/01%3A_Head_and_Neck/1.44%3A_Surgery_for_Pharyngeal_Pouch___Zenker’s_Diverticulum

  ZD is a pulsion diverticulum or herniation of esophageal mucosa and submucosa through Killians triangle, which is immediately proximal to the cricopharyngeus muscle. […] Of surgical importance is that the entire diverticulum is contained within the buccopharyngeal fascia, which itself is not involved in the formation of the diverticulum. […] This anatomic relationship between the ZD and the surrounding buccopharyngeal fascial layer is the key to understanding how the upper digestive tract remains separated from the retropharyngeal space when incising the anterior wall of the diverticulum, or in the case of an isolated endoscopic cricopharyngeal myotomy. Disrupting this fascial layer could theoretically increase the likelihood of developing mediastinitus. […] It is important to understand that after the ZD herniates through Killians dehiscence, it expands posterior to the cricopharyngeus and the superior esophageal muscles layers but is still contained within the perioesophageal fascia. This protective layer of investing fascia surrounding both the esophagus and ZD is the key to endoscopic division of the cricopharyngeus muscle and the entire party wall between the ZD and the esophagus. Without this fascial layer, saliva would be likely to track into the mediastinum causing mediastinitis.

• #21 Zenker’s Diverticulum: Endoscopic Staple-Assisted Diverticulotomy | Journal of Medical Insight

  https://jomi.com/article/275/zenker’s-diverticulum:-endoscopic-staple-assisted-diverticulotomy

  Zenker’s diverticulum (ZD) results from a posterior mucosal herniation through Killians triangle, an area situated above the cricopharyngeus (CP) muscle and below the inferior pharyngeal constrictor muscle. ZD is likely caused by incomplete relaxation of the upper esophageal sphincter as well as increased intraluminal pressure. […] The pathophysiology of ZD is unclear; however, certain risk factors such as abnormal esophageal motility, altered upper esophageal sphincter function, and aging predispose patients to its development. […] The goal of surgical treatment is to restore the continuity from the hypopharynx to the esophageal lumen without obstruction or retention of swallowed contents. There are two ways to accomplish this, either with elimination or circumvention of the reservoir that traps debris, and release of the upper esophageal sphincter by a cricopharyngeal myotomy. […] Rigid endoscopy generally has the same indications and contraindications as open surgical approaches; however, flexible endoscopy has the benefit of being able to be performed under deep sedation or on those with limited cervical mobility.

• #22 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,1.html

  Zenkers diverticulum occurrence is the consequence of esophageal mucosa membrane weakening with coexisting increase in UES tension. […] The increase in pressure during ingesta swallowing pushes esophageal tissue layers outside the esophagus to the mediastinum retropharyngeal space, forming a pouch with gates limited by muscles. […] Increase in pressure of the cricopharyngeal muscle results in decreased UES relaxation and subsequent further increase in pressure within the sphincter. […] The described mechanism results in the creation of an alternative route for ingesta. […] Individual susceptibility to diverticula occurrence is caused by fibrosis and histologically described inflammation within Killians triangle muscles fibers. […] The muscle dysfunction may be the consequence of diseases causing esophagus contraction, e.g. achalasia.

• #23 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,1.html

  In other cases the reason may by gastro-esophageal reflux disease with cricopharyngeal muscle cramp. […] A genetic predisposition to ZD occurrence has not been proven so far. […] The existence of such a predisposition is possible due to described congenital UES muscle weakness. […] Zenkers diverticulum is located more often on the left side of the esophageal wall, which has given rise to the suggestion that ZD occurrence may be dependent on whether the individual is right- or left-handed.

• #24 Zenker’s diverticulum – ENT Info

  https://www.entinfo.nz/zenkers-diverticulum/

  Zenkers diverticulum (ZD) is also known as pharyngeal pouch. […] The most accepted theory involves building up of pressure within the throat as a result of 1) abnormal tightening of a ring of muscle at the junction of the throat and food pipe called cricopharynxgeus and 2) excessive muscular activity in the throat. […] During swallowing, pressure inside the throat significantly increases and is a lot higher than the outside in those with a tight cricopharyngeus and high throat muscle resting tone. The unusually large pressure difference created at the natural weak area causes the throat wall to protrude and form a sac-like structure. […] There are some conditions that predisposed patients to ZD formation. The examples include various disorders of muscular activity and acid reflux or gastroesophageal reflux disease (GERD).

• #25 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,1.html

  In other cases the reason may by gastro-esophageal reflux disease with cricopharyngeal muscle cramp. […] A genetic predisposition to ZD occurrence has not been proven so far. […] The existence of such a predisposition is possible due to described congenital UES muscle weakness. […] Zenkers diverticulum is located more often on the left side of the esophageal wall, which has given rise to the suggestion that ZD occurrence may be dependent on whether the individual is right- or left-handed.

• #26 Zenker Diverticulum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/836858-overview

  The pathologic process in Zenker diverticulum involves herniation of the esophageal mucosa posteriorly between the cricopharyngeal (CP) muscle and the inferior pharyngeal constrictor muscles. Therefore, by strict definition, a Zenker diverticulum is a false diverticulum. The retention of food elements and secretions within the lesions pouch frequently leads to halitosis, regurgitation, aspiration, and dysphagia in patients. […] Although Zenker proposed that a pulsion mechanism affects the pharyngeal mucosa above the CP muscle, no consensus exists regarding a unifying concept of the cause of Zenker diverticula. The specific abnormality of the CP muscle has not been elucidated. Hypothetical abnormalities include the following: […] It is hypothesized that abnormal muscle activity in the cricopharyngeus results in a discoordination of the swallowing mechanism, which, when coupled with increased intraluminal pressure on the mucosa of the pharynx, results in the slow, progressive distention of the mucosa. As the weakest portion of this area is located posteriorly, this becomes the location of the pulsion diverticulum formation. […] Zenker diverticula extend into the left neck 90% of the time. This is likely due to the slight convexity of the cervical esophagus to the left side and to the more laterally positioned carotid artery on the left side, creating a potential space for the sac.

• #27 Zenker’s Diverticulum | Ento Key

  https://entokey.com/zenkers-diverticulum/

  Zenkers diverticulum is classically defined as a pulsion diverticulum between the cricopharyngeal muscle and inferior constrictor muscle in an area of weakness called Killians dehiscence or triangle, first described by Killian in 1907. […] However, there are other areas of weakness where pulsion diverticula may form, including Killian-Jamiesons area, between the oblique and transverse fibers of the cricopharyngeal muscle, and Laimers triangle, formed between the cricopharyngeal muscle and the most superior esophageal wall circular muscles. […] Theoretically, a diverticulum herniates to the side of less resistance. Accordingly, it is hypothesized that ZD is more prone to herniate to the left because the carotid artery is more laterally located on this side of the neck, making it less adherent to the adjacent prevertebral fascia, and because there the cervical esophagus has a slight convexity to the left.

• #28 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,1.html

  In other cases the reason may by gastro-esophageal reflux disease with cricopharyngeal muscle cramp. […] A genetic predisposition to ZD occurrence has not been proven so far. […] The existence of such a predisposition is possible due to described congenital UES muscle weakness. […] Zenkers diverticulum is located more often on the left side of the esophageal wall, which has given rise to the suggestion that ZD occurrence may be dependent on whether the individual is right- or left-handed.

• #29 Indication for the endoscopic treatment of Zenker’s diverticula – Rodríguez-Luna – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5814/html

  Zenkers diverticulum (ZD) is a false pulsion diverticulum located in Killians triangle. […] Although the pathophysiology has not been completely elucidated, an impaired relaxation of the cricopharyngeal muscle (CPM) has been identified as the leading mechanism. […] ZD is considered to originate from uncoordinated pharyngeal contractions and upper esophageal sphincter (UES) dysfunction. The increased hypopharynx intraluminal pressure during swallowing combined with incomplete CPM relaxation and inadequate opening of the UES result in luminal pressurization forcing the mucosa and submucosa to posterior herniation. […] Additionally, in aged population, numerous swallows requiring bolus clearance can also produce an increased intrabolus pressure, explaining the diseases high incidence in the elderly. […] Studies have also suggested that gastroesophageal reflux disease can predispose to increased pressure in the UES.

• #30 Dysphagia – Zenker’s diverticulum – Medizinonline

  https://medizinonline.com/en/dysphagia-zenkers-diverticulum/

  Zenkers diverticulum causes passenger disturbances in the pharyngoesophageal junction. Regurgitation and regurgitation of undigested food occur frequently. […] The most common diverticulum of the esophagus is Zenkers diverticulum. […] In 1877, the Erlangen pathologist Friedrich von Zenker analyzed and described the association of the existence of this diverticulum with an increase in intrapharyngeal pressure. […] Typical localization is a preexistent weak point of the dorsal wall of the pharynx between the cricopharyngeal and inferior constrictor pharyngis muscles, the Kilian triangle. Due to pressure, there may be an outpouching of the posterior pharyngeal wall with formation of a diverticulum, favored by increased tone of the cricopharyngeal muscle and impaired relaxation of the upper esophageal sphincter. […] The classification of Zenker diverticula is according to Brombart with grade 1 to 4.

• #31 Pathology and Treatment of Zenker Diverticulum | Basicmedical Key

  https://basicmedicalkey.com/pathology-and-treatment-of-zenker-diverticulum/

  Zenker diverticulum was initially described by Abraham Ludlow in 1769 when he discovered the pathology during the autopsy of a man who had died from obstructed deglutition. […] This pharyngoesophageal diverticulum was given its eponym after Dr. Friedrich Albert von Zenker who described the pathology in great detail nearly a century later, including the pathophysiologic postulate that it arose as a pulsion diverticulum secondary to high hypopharyngeal pressures during swallowing. […] The pathophysiology of Zenker diverticulum can be observed with manometry. Initial investigation by Ellis in 1969 suggested a discoordination between the pharyngeal and cricopharyngeal contractions—specifically, premature cessation of relaxation of the upper esophageal sphincter, preventing the oral bolus to transit normally into the esophagus.

• #32 Pathology and Treatment of Zenker Diverticulum | Basicmedical Key

  https://basicmedicalkey.com/pathology-and-treatment-of-zenker-diverticulum/

  This results in abnormally persistent hypopharyngeal increased pressures against a closed upper esophageal sphincter, which the authors suggested may explain the development of the pulsion diverticulum. […] Subsequent manometric studies by Cook and colleagues in 1992 have refined this understanding, as they demonstrated increased hypopharyngeal pressures during the transit of the oral bolus and the opening of the upper esophageal sphincter in patients with Zenker diverticulum, but no discoordination of relaxation and contraction of the sphincter. […] The constrictive physiology of the cricopharyngeus muscle, which resulted in this increased resistance to bolus flow, was substantiated in the publication by that same group of a histologic study of the structural abnormalities of the muscle in patients with Zenker diverticulum. […] Other researchers have corroborated abnormal histologic findings in the cricopharyngeus muscle of Zenker diverticula patients, and aberrant innervation of the muscle is one proposed theory of the development of these structural abnormalities.

• #33 Zenker’s diverticulum – Wikipedia

  https://en.wikipedia.org/wiki/Zenker%27s_diverticulum

  A Zenker’s diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a pseudo diverticulum or false diverticulum (only involving the mucosa and submucosa of the esophageal wall, not the adventitia), also known as a pulsion diverticulum. […] While traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker’s diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (known as Killian’s triangle, located superior to the cricopharyngeus muscle and inferior to the thyropharyngeus muscle). The result is an outpouching of the posterior pharyngeal wall, just above the esophagus.

• #34 Zenker’s diverticulum – Wikipedia

  https://en.wikipedia.org/wiki/Zenker%27s_diverticulum

  A Zenker’s diverticulum, also pharyngeal pouch, is a diverticulum of the mucosa of the human pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a pseudo diverticulum or false diverticulum (only involving the mucosa and submucosa of the esophageal wall, not the adventitia), also known as a pulsion diverticulum. […] While traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker’s diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (known as Killian’s triangle, located superior to the cricopharyngeus muscle and inferior to the thyropharyngeus muscle). The result is an outpouching of the posterior pharyngeal wall, just above the esophagus.

• #35 Zenker’s Diverticulum: Symptoms, Surgery, Causes

  https://www.healthline.com/health/zenkers-diverticulum

  When the upper esophageal sphincter doesn’t open all the way, it puts pressure on an area of the pharynx wall. This excess pressure gradually pushes the tissue outward, causing it to form the diverticulum. […] The formation of Zenkers diverticulum is related to upper esophageal sphincter dysfunction. […] Gastroesophageal reflux disease (GERD) and age-related changes in tissue composition and muscle tone are also thought to play a role in this process.

• #36 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,1.html

  In other cases the reason may by gastro-esophageal reflux disease with cricopharyngeal muscle cramp. […] A genetic predisposition to ZD occurrence has not been proven so far. […] The existence of such a predisposition is possible due to described congenital UES muscle weakness. […] Zenkers diverticulum is located more often on the left side of the esophageal wall, which has given rise to the suggestion that ZD occurrence may be dependent on whether the individual is right- or left-handed.

• #37 Zenker’s Diverticulum

  https://www.massgeneral.org/digestive/shed/conditions-we-treat/zenkers-diverticulum

  Zenker’s diverticulum is caused by a weakness in the muscles of the cervical esophagus (the tube between the mouth and the stomach). […] Zenker’s diverticulum happens in a very characteristic position in the posterior aspect of the esophagus in the neck. […] The risk factors for developing a Zenker’s diverticulum are somewhat unknown, but it is proposed that longstanding gastroesophageal reflux may contribute.

• #38 Zenker’s Diverticulum | Ento Key

  https://entokey.com/zenkers-diverticulum/

  Although it is widely accepted that ZD is an acquired pulsion diverticulum, considerable controversy exists about the mechanism of its formation. […] The original German description was later translated into English in New York in 1878, allowing wider dissemination of Zenkers findings. […] However, before Zenker, Bell proposed in 1816 that incoordination of the inferior constrictor muscle against a closed cricopharyngeal muscle resulted in this type of outpouching at regions of inherent weakness. […] Variations on this theme for the mechanism of formation of ZD have been debated ever since. […] Others noted a higher incidence of reflux and hiatal hernia in patients with ZD as well as epidemiologic observations that ZD occurs predominantly in populations with a high incidence of reflux, suggesting a possible relationship between the two. […] Regardless of the theory, the cricopharyngeal muscle is the common theoretical culprit behind the formation of ZD, and whether to address this muscle during surgical management has been debated through the years.

• #39 Zenker’s Diverticulum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/zenkers-diverticulum

  In Zenkers diverticulum, you have a pouch in the back of your throat. The pouch makes it hard for you to swallow food. Zenkers diverticulum typically affects people ages 70 to 90 and develops over time. You may have the condition for many years before you have symptoms. Healthcare providers treat the condition with surgery. […] A Zenkers diverticulum is an issue that affects your throat (pharynx). Its a pouch that forms at the bottom of your throat where your throat connects to your esophagus. The pouch traps food, making it hard for you to swallow. Zenkers diverticulum typically affects people aged 70 to 90. You may have this condition for years before you develop noticeable symptoms, and it doesnt go away on its own. Healthcare providers treat Zenkers diverticulum with surgery. […] Researchers dont know the exact cause but think issues with your cricopharyngeus muscle are to blame. This muscle is at the top of your esophagus. It opens (relaxes) to let food in and then closes. When you swallow food, powerful muscles in your throat push food down toward your cricopharyngeus muscle. When this muscle doesnt relax as it should, food gets caught in a muscular squeeze play that puts pressure on your pharynx wall. Over time, the pressure pushes tissue through the wall to make a pouch.

• #40 Experience in the treatment of Zenker’s diverticulum: a series of 18 cases

  http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-99572011000200005&lng=en&nrm=iso&tlng=en

  Zenkers Diverticulum is a hernia of the posterior hypopharyngeal membrane proximal to the upper sphincter of the esophagus. It occurs in the anatomical area known as Killians Triangle located between the oblique fibers of the inferior constrictor muscle of the pharynx and the transverse fibers of the cricopharyngeus muscle. […] There are multiple hypotheses and mechanisms attributing the formation of Zenkers diverticulum to factors such as hypertrophy, premature contraction of the cricopharyngeus muscle, abnormalities of relaxation, and a second deglutition movement with a closed upper esophageal sphincter (UES). […] Since the greatest incidence of this disorder occurs between the seventh and eighth decades of life, its development has been associated with changes related to age that affect the functioning and relaxation of the UES.

• #41 Zenker’s Diverticulum: Symptoms, Surgery, Causes

  https://www.healthline.com/health/zenkers-diverticulum

  When the upper esophageal sphincter doesn’t open all the way, it puts pressure on an area of the pharynx wall. This excess pressure gradually pushes the tissue outward, causing it to form the diverticulum. […] The formation of Zenkers diverticulum is related to upper esophageal sphincter dysfunction. […] Gastroesophageal reflux disease (GERD) and age-related changes in tissue composition and muscle tone are also thought to play a role in this process.

• #42 Indication for the endoscopic treatment of Zenker’s diverticula – Rodríguez-Luna – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5814/html

  Zenkers diverticulum (ZD) is a false pulsion diverticulum located in Killians triangle. […] Although the pathophysiology has not been completely elucidated, an impaired relaxation of the cricopharyngeal muscle (CPM) has been identified as the leading mechanism. […] ZD is considered to originate from uncoordinated pharyngeal contractions and upper esophageal sphincter (UES) dysfunction. The increased hypopharynx intraluminal pressure during swallowing combined with incomplete CPM relaxation and inadequate opening of the UES result in luminal pressurization forcing the mucosa and submucosa to posterior herniation. […] Additionally, in aged population, numerous swallows requiring bolus clearance can also produce an increased intrabolus pressure, explaining the diseases high incidence in the elderly. […] Studies have also suggested that gastroesophageal reflux disease can predispose to increased pressure in the UES.

• #43 Zenker’s Diverticulum: Symptoms and Treatment

  https://www.webmd.com/digestive-disorders/what-is-zenkers-diverticulum

  Zenkers diverticulum is a pouch or pocket that can form at the beginning of your digestive tract. It forms above the cricopharyngeal (CP) muscle, which is where your esophagus and pharynx come together. This can happen if the muscle doesnt work the way it should for example, by not opening or relaxing easily. The wall of the pharynx, above your esophagus, can then form a little pocket or pouch. […] The exact cause is unknown, since Zenkers diverticulum is quite rare. Less than 0.01% of the population develops this pouch. Doctors think that too much pressure in the esophagus can cause the CP muscle to malfunction. Pressure can also cause the tissue of the esophagus to tear, which can result in a Zenkers diverticulum. […] A pharyngeal diverticulum puts pressure on the area above your digestive tract when you swallow. Because of this, food and liquids have a harder time going down and passing into the esophagus. Materials can then get stuck in the pouch or your throat. This can cause you to regurgitate your food or drinks.

• #44 Zenker diverticulum | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/zenker-diverticulum-1?lang=us

  Zenker diverticulum, also known as a pharyngeal pouch, is a posterior outpouching of the hypopharynx, just proximal to the upper esophageal sphincter through a weakness in the muscle layer called the Killian dehiscence. […] A Zenker diverticulum is a pulsion-pseudodiverticulum and results from herniation of mucosa and submucosa through the Killian triangle (or Killian dehiscence), a focal weakness in the hypopharynx at the normal cleavage plane between the fibers of the two parts of the inferior pharyngeal constrictor muscle – the cricopharyngeus and thyropharyngeus. […] This phenomenon may lead to the creation of a sac with a narrow neck that can trap liquid and food. The distended sac may compress the cervical esophagus.

• #45 Zenker’s diverticulum: etiopathogenesis, symptoms and diagnosis. Comparison of operative methods

  https://www.termedia.pl/Zenker-s-diverticulum-etiopathogenesis-symptoms-and-diagnosis-Comparison-of-operative-methods,41,21701,1,1.html

  Zenkers diverticulum occurrence is the consequence of esophageal mucosa membrane weakening with coexisting increase in UES tension. […] The increase in pressure during ingesta swallowing pushes esophageal tissue layers outside the esophagus to the mediastinum retropharyngeal space, forming a pouch with gates limited by muscles. […] Increase in pressure of the cricopharyngeal muscle results in decreased UES relaxation and subsequent further increase in pressure within the sphincter. […] The described mechanism results in the creation of an alternative route for ingesta. […] Individual susceptibility to diverticula occurrence is caused by fibrosis and histologically described inflammation within Killians triangle muscles fibers. […] The muscle dysfunction may be the consequence of diseases causing esophagus contraction, e.g. achalasia.

• #46 Zenker’s diverticulum – Libre Pathology

  https://librepathology.org/wiki/Zenker%27s_diverticulum

  Zenker’s diverticulum is an outpouching of the mucosa and submucosa at the junction of the pharynx and esophagus. […] A malignancy (squamous cell carcinoma) may arise from it; seen in ~0.3% of cases. […] Relatively uncommon – but most common among esophageal diverticula. […] Squamous mucosa without nuclear atypia +/- parakeratosis. […] Compatible with Zenker’s diverticulum.

• #47 Zenker’s diverticulum – Libre Pathology

  https://librepathology.org/wiki/Zenker%27s_diverticulum

  Zenker’s diverticulum is an outpouching of the mucosa and submucosa at the junction of the pharynx and esophagus. […] A malignancy (squamous cell carcinoma) may arise from it; seen in ~0.3% of cases. […] Relatively uncommon – but most common among esophageal diverticula. […] Squamous mucosa without nuclear atypia +/- parakeratosis. […] Compatible with Zenker’s diverticulum.

• #48 1.44: Surgery for Pharyngeal Pouch / Zenker’s Diverticulum – Medicine LibreTexts

  https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Atlas_of_Otolaryngology_Head_and_Neck_Operative_Surgery/01%3A_Head_and_Neck/1.44%3A_Surgery_for_Pharyngeal_Pouch___Zenker’s_Diverticulum

  ZD is a pulsion diverticulum or herniation of esophageal mucosa and submucosa through Killians triangle, which is immediately proximal to the cricopharyngeus muscle. […] Of surgical importance is that the entire diverticulum is contained within the buccopharyngeal fascia, which itself is not involved in the formation of the diverticulum. […] This anatomic relationship between the ZD and the surrounding buccopharyngeal fascial layer is the key to understanding how the upper digestive tract remains separated from the retropharyngeal space when incising the anterior wall of the diverticulum, or in the case of an isolated endoscopic cricopharyngeal myotomy. Disrupting this fascial layer could theoretically increase the likelihood of developing mediastinitus. […] It is important to understand that after the ZD herniates through Killians dehiscence, it expands posterior to the cricopharyngeus and the superior esophageal muscles layers but is still contained within the perioesophageal fascia. This protective layer of investing fascia surrounding both the esophagus and ZD is the key to endoscopic division of the cricopharyngeus muscle and the entire party wall between the ZD and the esophagus. Without this fascial layer, saliva would be likely to track into the mediastinum causing mediastinitis.

• #49 Zenker’s Diverticulum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/zenkers-diverticulum

  In Zenkers diverticulum, you have a pouch in the back of your throat. The pouch makes it hard for you to swallow food. Zenkers diverticulum typically affects people ages 70 to 90 and develops over time. You may have the condition for many years before you have symptoms. Healthcare providers treat the condition with surgery. […] A Zenkers diverticulum is an issue that affects your throat (pharynx). Its a pouch that forms at the bottom of your throat where your throat connects to your esophagus. The pouch traps food, making it hard for you to swallow. Zenkers diverticulum typically affects people aged 70 to 90. You may have this condition for years before you develop noticeable symptoms, and it doesnt go away on its own. Healthcare providers treat Zenkers diverticulum with surgery. […] Researchers dont know the exact cause but think issues with your cricopharyngeus muscle are to blame. This muscle is at the top of your esophagus. It opens (relaxes) to let food in and then closes. When you swallow food, powerful muscles in your throat push food down toward your cricopharyngeus muscle. When this muscle doesnt relax as it should, food gets caught in a muscular squeeze play that puts pressure on your pharynx wall. Over time, the pressure pushes tissue through the wall to make a pouch.

• #50 A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome | Oyama | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2311/1721

  Symptoms associated with ZD may be present for weeks to years before its definite diagnosis. However, the trigger mechanism by which asymptomatic ZD changes into symptomatic ZD is unclear. Commonly, the size of ZD is strongly related to the appearance of the various symptoms; small diverticula may not cause symptoms, but larger diverticula are usually symptomatic and patients with very large diverticula may show a gurgling swelling that is palpable in the neck. […] The mainstay of treatment for symptomatic ZD is surgical management. Conservative management may be applicable to patients with small ZD ( 1 cm). An open approach is suitable for the treatment of large ZD and includes cricopharyngeal myotomy alone, or myotomy with diverticulectomy, diverticulopexy or diverticular inversion.

• #51 A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome | Oyama | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2311/1721

  Symptoms associated with ZD may be present for weeks to years before its definite diagnosis. However, the trigger mechanism by which asymptomatic ZD changes into symptomatic ZD is unclear. Commonly, the size of ZD is strongly related to the appearance of the various symptoms; small diverticula may not cause symptoms, but larger diverticula are usually symptomatic and patients with very large diverticula may show a gurgling swelling that is palpable in the neck. […] The mainstay of treatment for symptomatic ZD is surgical management. Conservative management may be applicable to patients with small ZD ( 1 cm). An open approach is suitable for the treatment of large ZD and includes cricopharyngeal myotomy alone, or myotomy with diverticulectomy, diverticulopexy or diverticular inversion.

• #52 Indication for the endoscopic treatment of Zenker’s diverticula – Rodríguez-Luna – Annals of Esophagus

  https://aoe.amegroups.org/article/view/5814/html

  Zenkers diverticulum (ZD) is a false pulsion diverticulum located in Killians triangle. […] Although the pathophysiology has not been completely elucidated, an impaired relaxation of the cricopharyngeal muscle (CPM) has been identified as the leading mechanism. […] ZD is considered to originate from uncoordinated pharyngeal contractions and upper esophageal sphincter (UES) dysfunction. The increased hypopharynx intraluminal pressure during swallowing combined with incomplete CPM relaxation and inadequate opening of the UES result in luminal pressurization forcing the mucosa and submucosa to posterior herniation. […] Additionally, in aged population, numerous swallows requiring bolus clearance can also produce an increased intrabolus pressure, explaining the diseases high incidence in the elderly. […] Studies have also suggested that gastroesophageal reflux disease can predispose to increased pressure in the UES.

• #53 A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome | Oyama | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/2311/1721

  Esophageal diverticula are rare, and are observed in less than 1% of upper gastrointestinal X-ray images. Among esophageal diverticula, Zenkers diverticulum (ZD) is commonly observed as a posterior pharyngoesophageal pouch having characteristics of a pseudodiverticulum and consisting of only mucosal and submucosal tissue, and is formed by pulsion forces in an area with relative wall weakness between the oblique fibers of the inferior pharyngeal constrictor and the horizontal fibers of the cricopharyngeus (CP) muscles. […] The most widely accepted mechanism for the development of ZD is a functional disturbance of the hypopharynx, including increased resting pressure of the UES, lack of sufficient relaxation, and lack of coordination between the hypopharynx and the UES. Patients with ZD may show dysfunction of the UES opening, replacement of the CP muscle fibers by fibrous adipose tissue, or a significant increase of the collagen to elastin ratio, leading to increased hypopharyngeal pressure due to decreased compliance of these muscles. Spastic condition of the CP muscle may also contribute to the onset of ZD.

• #54

  http://www.ucdvoice.org/zenkers-diverticulum/

  A Zenkers diverticulum (ZD) is a blind sac (pouch) that branches off the cervical esophagus. […] Although its precise etiology is uncertain, it is a pulsion type of diverticulum and is thought to arise from increased intraluminal pressure that is caused by incoordination of the the cricopharyngeus muscle (CPM). […] The increased pharyngeal pressure causes a pouch (ZD) to develop through the area of anatomic weakness (Killians dehiscence). […] The development of a ZD is thought to be secondary to prolonged dysfunction of the CPM over many years.

• #55

  http://www.ucdvoice.org/zenkers-diverticulum/

  A Zenkers diverticulum (ZD) is a blind sac (pouch) that branches off the cervical esophagus. […] Although its precise etiology is uncertain, it is a pulsion type of diverticulum and is thought to arise from increased intraluminal pressure that is caused by incoordination of the the cricopharyngeus muscle (CPM). […] The increased pharyngeal pressure causes a pouch (ZD) to develop through the area of anatomic weakness (Killians dehiscence). […] The development of a ZD is thought to be secondary to prolonged dysfunction of the CPM over many years.

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