Lateral pharyngeal diverticulum (Pharyngocele) is the protrusion of pharyngeal mucosa through the pharyngeal wall, usually through either of two weak areas in the pharyngeal wall as an acquired or congenital case. Lateral diverticula are very rare and not to be mistaken for the rather more frequent and abundantly reported cases of posterior pharyngo-esophageal diverticula (Zenker`s). Here, we present a case of this very rare condition in a young boy who presented with severe dysphagia since childhood.Key words: Lateral, pharyngeal, diverticulum dysphagia DOI: http://dx.doi.org/10.4314/ecajs.v21i3.19 Case SummaryA 16 year old male patient presented to our hospital with difficulty of swallowing of solid and liquid diet since childhood with worsening of these symptoms since the past three years. Patient swallows with significant effort while noticing bulging of his neck on the right side. There was no history of cardiac, respiratory or neurologic condition in the past, no history of trauma, surgery or neck infection Physical findings at admission included stable vital signs, otherwise unremarkable. Pertinent finding was noticed upon attempt at swallowing and with Valsalva maneuver with significant bulging of the right lateral neck which is cystic and reducible (Figure 1). No neck swelling on the left side.Hence with the diagnosis of dysphagia secondary to lateral pharyngeal diverticulum he was investigated. Routine lab work was normal. Barium swallow revealed an out-pouching on the right lateral side of the hypopharynx on the right pyriform recess (Figure 2). CT scan of the neck also revealed the diverticulum. On Endoscopy, the right side recess looked distorted with bulging mucosal folds and it was not possible to intubate the esophagus.The patient was subsequently operated with an initial incision made along the right anterior border of the sternocleidomastoid muscle and dissection was made to the level of the diverticulum which was arising between the middle and inferior pharyngeal constrictor muscles and the thyro-hyoid membrane. The diverticulum was subsequently opened and attempt was made to pass in a nasogastric tube and failed due to a tightly constricted cricopharyngeus muscle (Figure 3). Skin incision was then extended along the anterior border of the left sternocleidomastoid muscle and and dissection made to the level of the cervical esophagus which was mobilized and the right lobe of the thyroid gland was removed to gain better exposure of the cricopharyngeal junction.
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