Zenker's diverticulum natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
The Zenker's diverticulum (ZD) slowly start as a oropharyngeal dysphagia progressing from solids to liquids, regurgitation of undigested food from the diverticular sac, chronic aspiration, halitosis, chronic cough, sensation of a lump in the throat, hoarseness, borborygmi. If untreated can lead to complications such as aspiration pneumonia, bleeding of the diverticulum, ulceration of the diverticulum, compression of the trachea and esophageal obstruction with large diverticula, perforation, very rarely | The [[Zenker's diverticulum]] (ZD) slowly start as a [[oropharyngeal]] [[dysphagia]] progressing from solids to liquids, regurgitation of undigested food from the [[diverticular]] sac, [[chronic]] [[aspiration]], [[halitosis]], [[chronic]] [[cough]], sensation of a [[lump]] in the [[throat]], [[hoarseness]], [[borborygmi]]. If untreated can lead to complications such as [[aspiration pneumonia]], [[bleeding]] of the [[diverticulum]], [[Ulcer|ulceration]] of the [[diverticulum]], compression of the trachea and [[esophageal]] obstruction with large [[Diverticular|diverticula]], [[perforation]], very rarely [[squamous cell carcinoma]] of the [[diverticulum]]. Patients who undergo [[surgery]] have a very low recurrence rate of the [[Zenker's Divertitulum|ZD]]. | ||
==Natural History== | ==Natural History== | ||
*Symptoms of Zenker's diverticulum slowly start as a<ref name="urlZenkers diverticulum: exploring treatment options">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773964/ |title=Zenker's diverticulum: exploring treatment options |format= |work= |accessdate=}}</ref> | *Symptoms of [[Zenker's diverticulum]] slowly start as a<ref name="urlZenkers diverticulum: exploring treatment options">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773964/ |title=Zenker's diverticulum: exploring treatment options |format= |work= |accessdate=}}</ref> | ||
** Oropharyngeal dysphagia progressing from solids to liquids | ** Oropharyngeal [[dysphagia]] progressing from solids to liquids | ||
** Regurgitation of undigested food from the diverticular sac | ** [[Regurgitation]] of undigested food from the [[diverticular]] sac | ||
** Pharyngeal stasis of secretion | ** [[Pharyngeal]] [[stasis]] of [[secretion]] | ||
** Chronic aspiration | ** [[Chronic]] [[aspiration]] | ||
** Halitosis | ** [[Halitosis]] | ||
** Chronic cough | ** [[Chronic]] [[cough]] | ||
** Sensation of a lump in the throat | ** Sensation of a [[lump]] in the [[throat]] | ||
** Hoarseness | ** [[Hoarseness]] | ||
** Cervical borborygmi. | ** [[Cervical]] [[borborygmi]]. | ||
*The patient may note food on the pillow upon awakening in the morning. | *The patient may note food on the pillow upon awakening in the morning. | ||
*Although small diverticula may not cause symptoms, larger diverticula usually are symptomatic. | *Although small [[Diverticular|diverticula]] may not cause symptoms, larger [[Diverticular|diverticula]] usually are symptomatic. | ||
*Both the inability of the sphincter to fully open and the extrinsic compression from the pouch itself are likely to explain the dysphagia experienced by patients. | *Both the inability of the [[sphincter]] to fully open and the extrinsic compression from the pouch itself are likely to explain the [[dysphagia]] experienced by patients. | ||
*In patients with very large diverticula, a gurgling swelling in the neck can occasionally be detected on palpation. | *In patients with very large [[Diverticular|diverticula]], a gurgling [[swelling]] in the neck can occasionally be detected on [[palpation]]. | ||
==Complications== | ==Complications== | ||
* Complications of the Zenker's diverticulum includes<ref name="urlLong-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenkers) diverticulum. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=6433819 |title=Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker's) diverticulum. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlEsophageal diverticula and cancer. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=22335201 |title=Esophageal diverticula and cancer. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlThe treatment of pharyngoesophageal diverticulum: the simple and complex. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=1634177 |title=The treatment of pharyngoesophageal diverticulum: the simple and complex. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlCarcinoma arising in posterior pharyngeal pulsion diverticulum (Zenkers diverticulum). - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=3113525 |title=Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum). - PubMed - NCBI |format= |work= |accessdate=}}</ref> | * Complications of the [[Zenker's diverticulum]] includes<ref name="urlLong-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenkers) diverticulum. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=6433819 |title=Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker's) diverticulum. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlEsophageal diverticula and cancer. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=22335201 |title=Esophageal diverticula and cancer. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlThe treatment of pharyngoesophageal diverticulum: the simple and complex. - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=1634177 |title=The treatment of pharyngoesophageal diverticulum: the simple and complex. - PubMed - NCBI |format= |work= |accessdate=}}</ref><ref name="urlCarcinoma arising in posterior pharyngeal pulsion diverticulum (Zenkers diverticulum). - PubMed - NCBI">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmed?term=3113525 |title=Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum). - PubMed - NCBI |format= |work= |accessdate=}}</ref> | ||
* Aspiration pneumonia | * [[Aspiration pneumonia]] | ||
* Bleeding of the diverticulum | * [[Bleeding]] of the [[diverticulum]] | ||
* Ulceration of the diverticulum | * [[Ulceration]] of the [[diverticulum]] | ||
* Compression of the trachea and esophageal obstruction with large diverticula | * Compression of the [[trachea]] and [[esophageal]] [[obstruction]] with large [[Diverticular|diverticula]] | ||
* Very rarely Squamous cell carcinoma of the diverticulum | * Very rarely [[Squamous cell carcinoma]] of the diverticulum | ||
* Perforation of the diverticulum during the endoscopy and hence scopes with side viewing should be used to prevent perforation. | * [[Perforation]] of the [[diverticulum]] during the [[endoscopy]] and hence [[Scopes Trial|scopes]] with side viewing should be used to prevent [[perforation]]. | ||
==Prognosis== | ==Prognosis== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
The Zenker's diverticulum (ZD) slowly start as a oropharyngeal dysphagia progressing from solids to liquids, regurgitation of undigested food from the diverticular sac, chronic aspiration, halitosis, chronic cough, sensation of a lump in the throat, hoarseness, borborygmi. If untreated can lead to complications such as aspiration pneumonia, bleeding of the diverticulum, ulceration of the diverticulum, compression of the trachea and esophageal obstruction with large diverticula, perforation, very rarely squamous cell carcinoma of the diverticulum. Patients who undergo surgery have a very low recurrence rate of the ZD.
Natural History
- Symptoms of Zenker's diverticulum slowly start as a[1]
- Oropharyngeal dysphagia progressing from solids to liquids
- Regurgitation of undigested food from the diverticular sac
- Pharyngeal stasis of secretion
- Chronic aspiration
- Halitosis
- Chronic cough
- Sensation of a lump in the throat
- Hoarseness
- Cervical borborygmi.
- The patient may note food on the pillow upon awakening in the morning.
- Although small diverticula may not cause symptoms, larger diverticula usually are symptomatic.
- Both the inability of the sphincter to fully open and the extrinsic compression from the pouch itself are likely to explain the dysphagia experienced by patients.
- In patients with very large diverticula, a gurgling swelling in the neck can occasionally be detected on palpation.
Complications
- Complications of the Zenker's diverticulum includes[2][3][4][5]
- Aspiration pneumonia
- Bleeding of the diverticulum
- Ulceration of the diverticulum
- Compression of the trachea and esophageal obstruction with large diverticula
- Very rarely Squamous cell carcinoma of the diverticulum
- Perforation of the diverticulum during the endoscopy and hence scopes with side viewing should be used to prevent perforation.
Prognosis
Prognosis of ZD after the intervention is good, the recurrence of the diverticulum is very rare.[6]
References
- ↑ "Zenker's diverticulum: exploring treatment options".
- ↑ "Long-term survival following diverticulectomy for cancer in pharyngoesophageal (Zenker's) diverticulum. - PubMed - NCBI".
- ↑ "Esophageal diverticula and cancer. - PubMed - NCBI".
- ↑ "The treatment of pharyngoesophageal diverticulum: the simple and complex. - PubMed - NCBI".
- ↑ "Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum). - PubMed - NCBI".
- ↑ "www.sciencedirect.com.ezp-prod1.hul.harvard.edu".