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Gastroenterology
Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021
This patient has a Zenker’s diverticulum, a diverticulum of the mucosa of the pharynx (about the cricopharyngeal muscle). Consequently, the most beneficial investigation is a barium swallow. If the diverticulum is small and asymptomatic it may be treated conservatively. However, if the diverticulum is larger it may be resected by either open or endoscopic surgery.
Benign oesophageal obstruction
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
A large pharyngeal (Zenker’s) diverticulum is classically associated with the symptoms of persistent cough, fullness and gurgling in the neck, postprandial regurgitation and aspiration. Traction diverticula (Fig. 2.6) in the oesophagus also can produce dysphagia.
Functional Investigations of the Upper Gastrointestinal Tract
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Joanne M. Patterson, Jason Powell
Manometry is not frequently used as part of a routine clinical assessment in the UK. Robust guidance on who to select for this procedure is still in its infancy. However, the information derived can help to form a more detailed understanding of swallow breakdown. A small number of patients may not be able to tolerate the passage of a nasopharyngeal catheter and this may be contraindicated in those with recent nasopharyngeal surgery. Patients with suspected Zenker’s diverticulum will require X-ray guidance, to ensure correct catheter placement into the upper oesophagus. The range of manometric findings for different pathological processes is dealt with in Chapter 49, Causes and assessment of dysphagia and aspiration, and Chapter 53, Oesophageal diseases.
Myasthenic crisis as an initial presentation of myasthenia gravis in an 81-year-old following endoscopic myotomy for Zenker’s diverticulum
Published in Baylor University Medical Center Proceedings, 2023
Daniel Tran, Lucas Fair, Bryana Baginski, Bola Aladegbami, Steven Leeds, Marc Ward
An 81-year-old woman presented with dysphagia that had begun 4 months earlier and had progressed. Her past medical history was significant for anxiety, depression, hypothyroidism, and morbid obesity. To further evaluate her dysphagia, a barium esophagram was obtained and she was found to have a Zenker’s diverticulum (Figure 1). Due to her symptoms and imaging findings, she was scheduled for a per oral endoscopic myotomy for Zenker’s diverticulum (ZPOEM). The ZPOEM procedure was uneventful, and her postoperative esophagram showed no evidence of a leak. Normally, these patients are discharged on postoperative day 1; however, the patient continued to complain of dysphagia despite the success of the procedure, as seen on the postoperative esophagram (Figure 2). She was given dexamethasone to help with nausea and inflammation, which improved her dysphagia. She was discharged on postoperative day 2 when she demonstrated adequate oral intake.
Percutaneous endoscopic gastrostomy: a dislodgement complication due to a moving hiatal hernia
Published in Scandinavian Journal of Gastroenterology, 2021
Miia L. Lehtinen, Ilkka Ilonen, Juha Kauppi, Jari Räsänen
The EGD performed in a secondary care center revealed a large Zenker’s diverticulum (ZD) in the proximal esophagus. No passage was gained distal to ZD. A large concomitant hiatal hernia was also suspected in the chest x-ray. As the patient had malnourishment due to dysphagia, resulting in severe progressive weight loss, need for an enteral feeding route was urgent and the patient was referred to a tertiary center. Surgical treatment for ZD was discussed but to improve the nutritional status before definitive surgery, the patient was consented for PEG insertion under general anesthesia. Passage distal to ZD in the EGD was time-consuming. When finally entering the stomach, a type-III uncomplicated paraesophageal hernia was noted. After an endoscopic repositioning maneuver, passage to duodenum was gained. Cutaneous transillumination was visible in the abdominal wall and a 20-Fr MIC-PEG tube (Halyard, GA, USA) was inserted using the pull-technique. A repeat EGD was abandoned due to the complicated passage distal to the ZD. A computed tomography (CT) was performed after the insertion, confirming the suspected large hiatal hernia with 50% of the stomach detected above the diaphragm plane. The MIC-PEG location was satisfactory in the gastric body below the diaphragm (Figure 1(A and B)).
The role of fluoroscopy in diagnosing a Killian–Jamieson diverticulum
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Diverticula are difficult to appreciate on endoscopy and so Barium studies are the gold standard [5]. It is easier to estimate the size of the sac and approximate location to the cervical esophagus on barium studies, and thus these two diverticula can be only differentiated this way [4]. A Zenker’s diverticulum is visualized in the posterior wall of the pharynx on lateral imaging and often with a prominent cricopharyngeal bar [1]. The KJD is best seen on anteroposterior views below the cricopharyngeal muscle as a lateral outpouching [1]. If the diverticulum is long and inferiorly displaced, it can often be difficult for a radiologist to distinguish between the two. Zenker’s diverticulum is known to be almost twice as big as KJD and typically presents with more severe symptoms [5]. There are limited studies to assess the management and complications of KJD [6]. However, some reports of unilateral KJD have been treated with esophagomyotomy [1,7].