Surgery for Killian-Jamieson diverticulum: a report of two cases

Abstract

Background Killian-Jamieson diverticulum (KJD) is a rare diverticulum arising from a muscular gap in the anterolateral wall of the proximal cervical esophagus. The first choice of treatment for KJD remains controversial due to its rare incidence. Here, we report two cases of KJD for which we performed different surgery: diverticulectomy in one case and diverticulopexy in the other. Case presentation Case 1 involved a 58-year-old woman presenting progressive pharyngeal discomfort for the past year. She was diagnosed as KJD using endoscopic and radiographic findings. She underwent diverticulectomy with cricopharyngeal and proximal esophageal myotomy. Staple line leakage developed at 1 month after surgery and was successfully treated conservatively. At 5 months after surgery, she was asymptomatic. Case 2 involved a 77-year-old woman presenting dysphagia for the past 2 years. She had a history of bilateral breast cancer and had hypertension, asthma, and osteoporosis. Taking her age and medical history into account, we selected diverticulopexy with cricopharyngeal and proximal esophageal myotomy. The postoperative course was uneventful. At 2 years after surgery, she remained free of dysphagia. Conclusion The first choice of surgery for KJD is diverticulectomy. In a high-risk patient, diverticulopexy is a reasonable treatment. We recommend the addition of myotomy as a part of any surgical treatment.

Endoscopic observation of the palisade vessels in Killian–Jamieson diverticulum was useful for diagnosis and surgical treatment: a case report

“…ZD arises from a muscular gap in the posterior wall below the inferior pharyngeal constrictor muscle and above the cricopharyngeus muscle, known as Killian's triangle (Fig. 3) [3]. KJD arises from a muscular gap in the anterolateral wall of the cervical esophagus just below the cricopharyngeus muscle and superolateral to the longitudinal muscle of the esophagus, known as the Killian-Jamieson area (Fig.…”

“…KJD arises through a muscular gap in the anterolateral wall of the cervical esophagus just below the cricopharyngeus muscle and superolateral to the longitudinal muscle of the esophagus, known as the Killian-Jamieson area esophageal myotomy. Myotomy is mandatory for ZD because its pathogenesis is regarded as insufficient relaxation of the muscles that comprise the UES and high pressure in the hypopharynx [1][2][3]. Unlike ZD, KJD is not associated with UES dysfunction and does not therefore require myotomy [2,4].…”

“…Esophagography is commonly used to distinguish between the two types [3,6,7]. ZD is located above the cricopharyngeal bar, which represents constriction of the cricopharyngeus muscle that comprises the UES, whereas KJD is located below the cricopharyngeal bar.…”

“…Surgical treatment of the pharyngoesophageal diverticulum, known as Zenker’s diverticulum (ZD), which arises above the cricopharyngeus muscle, requires cricopharyngeal and esophageal myotomy in addition to diverticulectomy [ 1 – 3 ]. Killian–Jamieson diverticulum (KJD), on the other hand, which arises below the cricopharyngeus muscle, does not require myotomy [ 2 , 4 ].…”

A novel Killian–Jamieson diverticulectomy using a thyroid gland flap: a case report

“…Suture or staple line leakage following diverticulectomy reportedly occurs in 1.7% to 12.7% of cases [7], and this complication poses a risk of cervical infection and stenosis [5]. Although surgery for KJD is rare, one case report described the occurrence of staple line leakage that was treated by enforced fasting [4].…”