Pharyngoesophageal Obstruction on the Killian-Laimer Triangle by Zenker’s Diverticulum: Case Report and Clinical Significance

Abstract

Zenker’s diverticulum is a form of esophageal and pharyngeal obstruction located at the Killian-Laimer triangle. It is relatively common in elderly man (seventh or eighth decade of life), and its pathophysiology is not completely understood, albeit theories regarding dysfunction of the upper esophageal sphincter were reported. The main symptoms are dysphagia and odynophagia, but it can complicate to aspiration and perforation of the pharyngeal pouch; also, it can be asymptomatic. Diagnosis is provided through a barium esophagogram. Treatment can be performed through endoscopic surgery, diverticulopexy and myotomy of the cricopharyngeus muscle, although there is no consensus among surgeons regarding the treatment of choice. We report a case of pharyngeal obstruction due to Zenker’s diverticulum which caused massive weight loss in a 76-year-old male.

Zenker's diverticulum misinterpreted as a thyroid mass: Case report

“…A clear understanding of the pathogenesis underlying development of a pharyngeal pouch is missing. The most accepted theory is based on a physiological abnormality above the cricopharyngeal muscle at the level of the upper oesophageal sphincter [ 3 , 4 ]. This anatomical location is called Killian's triangle and pharyngeal pouch is also known as a Killian's dehiscence [ 3 , 5 ] which is an area of muscular weakness between the transverse cricopharyngeal fibres and oblique fibres of thyropharyngeal muscle.…”

“…This theory is further supported by malfunctioning of the cricopharyngeal muscle, the inability of the sphincter to relax and causing a raised hypopharyngeal (intrabolus) pressure during swallowing. The raised intrabolus pressure can be confirmed using specialized cricopharyngeal pH manometry [ [3] , [4] , [5] , [6] ]. The intrabolus pressure is significantly higher in patients with a diverticulum in comparison to aged matched population without a pharyngeal pouch.…”

“…The diverticulum typically presents with various symptoms including chest pain, chronic cough due to aspiration, dysphagia, halitosis, regurgitation, and weight loss. As the pharyngeal pouch enlarges patients can become more symptomatic, malnourished, and often suffer from significant weight loss [ 1 , 3 , 4 ].…”

Fine‐needle aspiration cytology of a Zenker's diverticula‐mimicking thyroid nodule

“…Dear Dr. Lester Layfield, Zenker's diverticulum (ZD) is a relatively uncommon disorder (0.01%-0.11%) 1 characterized by a loss of mucosa and submucosa muscle elasticity leading to an outpouching of tissue through the Killian triangle, 2 yet is the most common diverticulum of the esophagus. 3 ZD occurs mostly in the elderly and is frequently asymptomatic.…”

“…3 ZD occurs mostly in the elderly and is frequently asymptomatic. [1][2][3] Fine-needle aspiration cytology (FNAC) is a widely used, costeffective tool for the evaluation of thyroid nodules. Non-thyroidal lesions, such as diverticula, can sometimes be mistaken for thyroid nodules on ultrasound and aspirated.…”