Overview
Definition
A posterior pharyngeal herniation (pulsion diverticulum) of mucosa through Killian's triangle, just superior to the cricopharyngeus muscle.
Epidemiology
More common in elderly patients (over 70 years old) and males.
Etiology & Risk Factors
- Increased intraluminal pressure in the distal oropharynx due to incoordination or spasm of the cricopharyngeal muscle
Clinical Symptoms
- Dysphagia
- Halitosis (extremely foul breath from undigested food trapped in pouch)
- Regurgitation of undigested food while sleeping
- Coughing / Choking after swallowing
- Neck mass (sometimes compressible, yielding gurgling sounds)
Clinical Approach
Diagnosis
- Barium swallow (diagnostic, showing pouch extending posteriorly)
- *Note: Upper endoscopy is contraindicated or must be performed with extreme caution due to risk of perforation*
Management
- Surgical diverticulectomy and cricopharyngeal myotomy
- Endoscopic stapling or division of the cricopharyngeal muscle (Dohlman procedure)
Complications
- Aspiration pneumonia
- Esophageal perforation
- Squamous cell carcinoma in diverticulum (rare)