Diagnostic difficulties in a patient with Zenker diverticulum
Esophageal diverticulum has an incidence of less than 1% in the population, 70% occur in the cervical esophagus and are known as Zenker diverticulum. The treatment is indicated in symptomatic patients - dysphagia being a constant symptom.
Current treatment includes minimally invasive transoral tehnics for septum dividing between diverticulum and esophagus, either with stapler or via interventional endoscopy, as well as the open technique: diverticullectomy with cervical crycopharyngiomyotomy - for large diverticulums.
We present the case of a 74-yo patient, with dysphagia, regurgitation, and weight loss with progressive 2-year evolution. After an ambulatory thyroid ultrasonography that raised suspicion of a Zenker diverticulum, was reffered to gastroenterology service, where UGI endoscopy have not revealed esophageal pathology and recommends cervical CT: a voluminous diverticulous pouch in contact with the left sternocleidomastoid muscle with food remnants. (Fig.A)
She is admitted to hospital for further investigations. Barium swallow: an oval round image in the cervical region, approximately the size of 3 cervical vertebrae, retentive (fig. B)
EDS: broad diverticular communication with cervical esophagus, voluminous diverticulum with food and barium remnants(Fig. C)
A cervical approach was decided: diverticulumlectomy with a TA 55mm stapler (Fig. D), the stapling line was reinforced by another polyglicolic 3-0 serumuscular running suture and cricopharyngeal myotomy (Fig. E)
The postoperative evolution was unremarkable.
The low incidence of this disease and the actual management controversy are recommendations for the treatment of patients in clinics with experience in esophageal surgery.
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