Diverticulum

• Types of diverticulum:

  • Paraesophageal: located in the upper area of the esophagus
  • Zenker’s diverticulum: aka pharyngeoesophageal pulsion diverticulum, most common type located in the cricopharyngeal muscle (midline of the neck), increased incidence in men over 60 years old
  • Midesophageal: uncommon with less acute symptoms
  • Epiphrenic diverticulum: located in the lower area just above the diaphragm, larger diverticula
  • Intramural border of the esophagus: numerous small diverticula associated with stricture of the upper esophagus
• Symptoms of Paraesophageal diverticulum:

  • Dysphagia
  • Fullness on the neck
  • Regurgitation of undigested food
  • Gurgling noise after eating
  • Coughing
  • Halitosis
  • Sour taste in the mouth
• Symptoms of Epiphrenic diverticulum:

  • One third are asymptomatic
  • Two thirds complain of dysphagia and chest pain
• • Esophagoscopy: usually contraindicated due to possible perforation, before NPO-PM, during lateral position with anesthesia to throat, after may experience hoarseness or sore throat
• Assessment and Diagnostic Findings:

  • Barium swallow: x-ray with contrast dye, contraindicated in bowel obstruction, before NPO 8hrs, during drink through a straw and swallow contrast medium (barium sulfate), after use laxatives to evacuate barium
  • Manometric studies: measures lower esophageal sphincter pressure, graphic recording of swallowing waves, before NPO 8hrs, during swallow tiny tubes for pressure measurements, after may experience mild sore throat
• Management:

  • Zenker’s diverticulum: Diverticulectomy (surgical removal of the diverticulum)
  • Myotomy of the cricopharyngeal muscle: to relieve spasticity of the muscle
  • Epiphrenic and Midesophageal diverticulum: surgery is only indicated if symptoms are troublesome
• Risk factors for diverticular disease include low fiber diet, obesity, smoking, alcohol use, sedentary lifestyle, and chronic constipation