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2.1
Congenital Esophageal Diverticulum

Presentation

Presentation in infants and children is rarely seen. Zenker diverticula typically present in people older than 50 years and especially present during the seventh and eighth decades of life. References Herbella FA, Patti MG. (2012, Jan). [review.ttu.edu.vn]

MC presentation : Dysphagia (Intermittent) Earliest presentation : Regurgitation (Also with Achlasia and GERD ) Note : In Achlasia and Zenker - Old food regurgitates In GERD - Fresh food regurgitates. [mediconotebook.com]

We present the case of a 77-year-old woman with a large acquired tracheal diverticulum who presented many difficulties for orotracheal intubation and hemoptysis. [archbronconeumol.org]

The clinical presentation of an H type fistula is different than the other fistulae because it does not share the common presenting signs associated with atretic esophagus. [pedclerk.uchicago.edu]

Milder cases can present later in life, sometimes even in adulthood. [patient.info]

Entire Body System

  • Weakness

    Killian-Jamieson diverticula occur in a triangular area of weakness in the cervical esophagus below the cricopharyngeus muscle in contrast to Zenker's diverticula. [med-ed.virginia.edu]

    […] secondary to scarring, fibrosis and inflammatory processes (tuberculous adenitis) in the mediastinum pulling on the esophageal wall pulsion diverticula : are usually false diverticula and occur secondary to abnormal increased intraluminal pressure against a weak [radiopaedia.org]

    Esophageal Diverticula Esophagus Dysphagia Odynophagia Chest pain Chronic cough A feeling of food stuck in the throat Heartburn Regurgitation Bad breath Aspiration pneumonia Motility disorder Achalasia Esophageal scleroderma A weakness in the esophageal [nm.org]

    Pulsion diverticula form as a result of high intraluminal pressures against weaknesses in the GI tract wall. Zenker diverticulum occurs due to increased pressure in the oropharynx during swallowing against a closed upper esophageal sphincter. [review.ttu.edu.vn]

    It has been proposed that the cause of this difference is the relative weakness presented by the right paratracheal region compared with the left due to the presence of the aortic arch and the esophagus, which provide structural support to the tracheal [archbronconeumol.org]

  • Weight Loss

    Physical examination The most common symptoms are dysphagia, achalasia, weight loss, and regurgitation. Assess the patient’s appearance, noting apparent weight loss or the malnourished look that is associated with anorexia. [medical-dictionary.thefreedictionary.com]

    Dysphagia, food regurgitation, chest pain, weight loss, and reflux symptoms are the most commonly encountered gastrointestinal symptoms. [gastrointestinalatlas.com]

    A 58-year-old man presented to the family medicine clinic with several months of weight loss and difficulty swallowing. He reported that solid foods were “getting stuck” in his throat. [aafp.org]

    Weight loss is frequent as a result of difficulty swallowing and, in late stages, because of anorexia. Bleeding is rare. Physical examination will reveal signs of weight loss. In some cases, supraclavicular nodes may be detected. [clevelandclinicmeded.com]

    loss, night sweat, and decreased stress resistance. [lecturio.com]

  • Pathologist

    Providing practical information useful in the treatment of patients, this book will be of great value to gastroenterologists, allergists, pathologists, medical residents, fellows, internists, and general practitioners who treat patients with eosinophilic [books.google.de]

    Outstanding images – including gross pathology, a wide range of pathology stains, and detailed medical illustrations – make this an invaluable diagnostic aid for every practicing pathologist, resident, or fellow. [books.google.com]

    Yantiss, MD, Professor of Pathology and Laboratory Medicine, Chief, Gastrointestinal Pathology, Weill Cornell Medical College, New York, New York Description: Diagnostic Pathology: GI Endoscopic Correlation is designed for the gastrointestinal pathologist [euro-libris.ro]

    Participation of a speech pathologist or feeding therapist with pediatric expertise markedly improves the diagnostic utility of a feeding observation, and a diagnostic feeding is often carried out with concurrent radiographic assessment (see below). [nature.com]

  • Surgical Procedure

    This surgical procedure is thus recommended for patients with congenital esophagobronchial fistula with esophageal diverticulum. [jstage.jst.go.jp]

    Surgical Treatment Zenkers- There are several different surgical procedures employed for treatment of Zenkers diverticula with the preferred option being concomitant diverticulectomy and cricopharyngeal myotomy. [clinicaladvisor.com]

    Pediatric studies of this use of these agents are even rarer than adult studies. 128 Procedural or Surgical Treatments Procedures to treat oropharyngoesophageal dysmotility include those directed at management of oral cavity disorders, provision of nutrition [nature.com]

  • Swelling

    Sign : Swelling, changing size, gurgling sound - Boyce's Sign (Actual it is for laryngocele) Investigation of choice : Barium swallow. [mediconotebook.com]

    […] sounds; presence of dysphagia, choking, or regurgitation Changes (improvement or lack of improvement) of symptoms Halitosis, dysphagia, regurgitation, gurgling with swallowing, coughing, persistence of a bad taste in the mouth Complications: Airway swelling [medical-dictionary.thefreedictionary.com]

Respiratoric

  • Pharyngitis

    Diverticulum, Pharyngoesophageal Pulsion Diverticulum, Zenker's Diverticulums, Esophagopharyngeal Esophago Pharyngeal Diverticula Esophago Pharyngeal Diverticulum Esophago-Pharyngeal Diverticula Esophago-Pharyngeal Diverticulum Esophagopharyngeal Diverticulum [finto.fi]

    Zenker (pharyngeal) diverticula are posterior outpouchings of mucosa and submucosa through the cricopharyngeal muscle, probably resulting from an incoordination between pharyngeal propulsion and cricopharyngeal relaxation. [merckmanuals.com]

    Zenker diverticulum) They can be classified according to their location: Upper esophageal diverticula Zenker diverticulum : actually pharyngeal but it is common practice to include it with esophageal diverticula Killian-Jamieson diverticulum Middle esophageal [radiopaedia.org]

    There is usually a single opening at Killian's dehiscence, although the presence of a double pharyngeal pouch has been reported.the majority of pharyngeal pouches protrude to the left side and it has been suggested that the handedness of the patient may [gastrointestinalatlas.com]

    They differed in size and shape from congenital posterior pharyngeal diverticula previously on record and might represent different stages in the development of the abnormality. [link.springer.com]

Gastrointestinal

  • Dysphagia

    Causes of Intermittent Dysphagia : Zenker's diverticulum Eosinophilic esophagitis. [mediconotebook.com]

    Pharyngeal dysphagia: what the radiologist needs to know. Curr Probl Diagn Radiol. 2009;38(1):17–32. 3. Tobin RW. Esophageal rings, webs, and diverticula. J Clin Gastroenterol. 1998;27(4):285–295. 4. Spieker MR. Evaluating dysphagia. [aafp.org]

    Whether dysphagia occurs with solids or liquids is important; solid dysphagia precedes liquid dysphagia in disorders that anatomically narrow the esophagus, whereas liquid dysphagia is an early manifestation of disorders of motility. [nature.com]

    Case description This 17 year old lady had dysphagia since her childhood Multiple esophageal rings are a very unusual cause of dysphagia, Esophageal rings usually exist as a single lesion but can be multiple. [medtube.net]

  • Choking

    TD was born at 39 5/7 weeks gestational age and did well at home with the exception of "choking during feeds 2-4 times per day" with mild cyanosis. [ncbi.nlm.nih.gov]

    Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass. [med-ed.virginia.edu]

    If the diverticulum compresses the trachea or is associated with oesophageal stenosis or fistula, the symptoms of stridor, progressive dysphagia, respiratory distress, severe choking, and regurgitation may be present from birth. [medicbind.com]

    Recommend that the patient sleep with the head elevated (using pillows or bed blocks) to reduce esophageal reflux and nocturnal choking. [medical-dictionary.thefreedictionary.com]

    The diagnosis of an H type fistula is made earlier if the fistula is larger as infants will present with choking during feeding due to large aspirations. [pedclerk.uchicago.edu]

  • Regurgitation of Undigested Food

    Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass. [med-ed.virginia.edu]

    Patients present with upper esophageal dysphagia, regurgitation of undigested food, aspiration, noisy deglutition, halitosis, and changes in voice. Mild-to-moderate weight loss is frequent. [gastrointestinalatlas.com]

    It manifests mostly as dysphagia and regurgitation of food. [lecturio.com]

  • Gastropathy

    Gastritis Collagenous Gastritis Hypertrophic Gastropathies Hypoproteinemic Hypertrophic Gastropathy Zollinger-Ellison Syndrome Epithelial Polyps and Neoplasms of Stomach Hyperplastic Polyps Fundic Gland Polyps Pyloric Gland Adenoma Gastric Dysplasia [euro-libris.ro]

Jaw & Teeth

  • Halitosis

    Dysphagia, cough, halitosis, and regurgitation of food are common. 1, 2 Complications may include aspiration pneumonia and, less commonly, bleeding and fistula formation. 1 For symptomatic, large diverticula, open or endoscopic surgical repair may be [aafp.org]

    Zenker's diverticula are often found in older patients who present with dysphagia, regurgitation of undigested food, choking, hoarseness, halitosis or even a neck mass. [med-ed.virginia.edu]

    Note halitosis, a common sign of esophageal diverticula. Inspect the patient’s neck for visible signs of esophageal distention that has been caused by food trapped in the diverticula. [medical-dictionary.thefreedictionary.com]

    […] diffuse esophageal spasm, achalasia, esophageal hiatal hernia or reflux esophagitis.Diveritikuluma size varies from small to extremely large, which can even move only the body of the esophagus and lead to extreme dysphagia.And in these patients is present halitosis [refluxcentar.com]

    Patients present with upper esophageal dysphagia, regurgitation of undigested food, aspiration, noisy deglutition, halitosis, and changes in voice. Mild-to-moderate weight loss is frequent. [gastrointestinalatlas.com]

Cardiovascular

  • Hypertension

    […] diverticula Pulzioni diverticulum pharynx (hypopharynx) and esophagus are pseudodivertikulume in which the mucosa and submucosal layer pass through the muscle making baggy enlargement.Histopathological basis is being pulzionih diverticulum is always hypertensive [refluxcentar.com]

    Distal esophageal diverticula (epiphrenic diverticula) also occur in the presence of increased esophageal pressures as a result of dysmotility and Lower Esophageal Sphincter dysfunction (achalasia, hypertensive LES). [clinicaladvisor.com]

    Presence of abdominal viscera in the chest interferes with lung development and can result in pulmonary hypoplasia and pulmonary hypertension in severe cases. [patient.info]

    Stomach Congenital and Acquired Structural Anomalies Pyloric Stenosis Cysts and Duplications Pancreatic Heterotopia and Metaplasia of Stomach Motility Disorders Gastric Bezoar Vascular Abnormalities and Gastric Bleeding Dieulafoy Lesion of Stomach Portal Hypertensive [euro-libris.ro]

    A 66-year-old female with hepatic cirrhosis due to prolonged use of of acetaminophen and portal hypertension with tense ascites. Patient has a mild bleeding. For more endoscopic details, download the video clip by clicking on the endoscopic image. [gastrointestinalatlas.com]

  • Cyanosis

    TD was born at 39 5/7 weeks gestational age and did well at home with the exception of "choking during feeds 2-4 times per day" with mild cyanosis. [ncbi.nlm.nih.gov]

    Infants born with congenital esophageal atresia/TE fistula present with coughing, gagging, cyanosis, vomiting, voluminous oral secretions, and possibly respiratory distress. [pedclerk.uchicago.edu]

    Conspicuous symptoms in a newborn are frequent coughing attacks and salivate, triggered by mislead food and rattling respiration with respiratory disorders, inlcuding even cyanosis. [lecturio.com]

    […] only one of the two studies that disclosed the abnormality, highlighting the importance of considering this testing in infants with nonspecific feeding problems, that is, in infants who are well when not feeding, but develop coughing, choking, gagging, cyanosis [nature.com]

Psychiatrical

  • Withdrawn

    To overcome the pressure exerted by the diverticulum in the upper esophageal sphincter, we used a pediatric endoscope to perform the endoscopy with some difficulty the scope is passed into the esophagus, and then slowly withdrawn. [gastrointestinalatlas.com]

    In pill injury the offending medication should be withdrawn and antireflux therapy prescribed to prevent exacerbation of the injury. When odynophagia is pronounced, the use of topical anesthetic agents administered orally may help relieve the pain. [clevelandclinicmeded.com]

Workup

X-Ray

  • Esophageal Motility Disorder

    Motility Disorders 1887 Thomas W Shields 2069 Barretts Esophagus 1925 166 Radiographic Computed Tomographic 2079 Cardial Incompetence and Associated Mediastinum 2103 Katherine A Barsness and Marleta Reynolds 168 Mediastinal Tumor Markers 2131 Esophageal [books.google.com]

    Traction diverticula of either the congenital or acquired variety are not usually accompanied by an esophageal motility disorder. [hon.ch]

    Epiphrenic diverticula occur just above the diaphragm and usually accompany a motility disorder ( achalasia, diffuse esophageal spasm ). [merckmanuals.com]

    […] web 食道運動障害 esophageal motility disorder, motor disorders of the esophagus 食道炎 esophagitis アルカリ性逆流性食道炎 alkaline reflux esophagitis 逆流性食道炎 reflux esophagitis 腐食性食道炎 corrossive esophagitis 食道癌 carcinoma of the esophagus 食道胃接合部癌 cancer of esophagogastric [jsge.or.jp]

    Esophageal and Lower Esophageal Sphincter Motility Disorders (Smooth Muscle) Primary Esophageal Motor Disorders Achalasia is the most common primary esophageal motility disorder in children. 13 Recent reviews and descriptions of sizable pediatric series [nature.com]

Treatment

Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances. [books.google.de]

At the time the diagnosis is made, for 95 % of the tumors, palliative treatment is the only treatment option left. [lecturio.com]

Surgical treatment of pharyngoesophageal diverticulum (Zenker’s diverticulum). Surg Rounds 1982; 5: 18–24. Google Scholar Bertelsen S, Aasted A. Results of operative treatment of hypopharyngeal diverticulum. Thorax 1976; 31: 544–7. [link.springer.com]

treatment of symptomatic esophageal diverticula. [websurg.com]

Prognosis

Prognosis : guarded to poor. Pathogenesis Etiology Congenital or acquired. [vetstream.com]

[…] mid esophagus at level of tracheal bifurcation; becoming uncommon; previously mostly due to tuberculosis, mediastinal lymphadenitis and scarring; may be due to motor dysfunction, congenital or alkali ingestion ( Med Hypotheses 2004;62:931 ); better prognosis [pathologyoutlines.com]

Even in adenocarcinoma which is less sensitive to chemo and radiotherapy, combined treatment improves prognosis. [clevelandclinicmeded.com]

Overall, prognosis is rather bad since the first noticeable symptom of the disease, dysphagia, is a late symptom already. At the time the diagnosis is made, for 95 % of the tumors, palliative treatment is the only treatment option left. [lecturio.com]

Prognosis and Patient Counseling. Both surgical and endoscopic modalities have high success rates for symptom improvement (>90%). Surgical intervention does have an associated perioperative mortality of approximately 1.8%. [clinicaladvisor.com]

Etiology

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

The possibility of a secondary motor disorder in the etiology of the diverticulum must be considered in these circumstances. [hon.ch]

Pathogenesis Etiology Congenital or acquired. [vetstream.com]

They are categorized primarily by anatomic location and etiology into pulsion and traction diverticula. [ctsnet.org]

The etiology is controversial and is probably due to elevated upper esophageal pressure, cricopharyngeus dysfunction and reflux. [radiologyassistant.nl]

Epidemiology

The epidemiology of tracheo-oesophageal fistula and oesophageal atresia in Europe. EUROCAT Working Group. Arch Dis Child 1993; 68:743. GeneReviews™ [Internet]. Pagon RA, Bird TD, Dolan CR, et al., editors. [pedclerk.uchicago.edu]

An epidemiological study reviewed data from 2002 to 2006 in 30 countries and estimated a worldwide incidence of about 0.8 per 1,000, which is much lower than older studies. [ 6 ] The incidence of cleft palate alone is about 1 in 2,000. [patient.info]

Epidemiology Age Most esophageal diverticula occur in middle-aged adults and elderly people. Presentation in infants and children is rarely seen. [emedicine.medscape.com]

While there are differences between squamous cell carcinoma and adenocarcinoma in epidemiology, location and patterns of spread, both diseases tend to spread early outside the esophagus and both share a rather poor prognosis unless discovered early. [clevelandclinicmeded.com]

Finally, many disorders of these organs that occur in adulthood also occur in childhood, but may have different epidemiology, manifestations, or optimal management in these younger patients. [nature.com]

Pathophysiology

This volume provides a history of Eosinophilic Esophagitis (EoE), a basic understanding of the physiology of the eosinophil, and a current understanding of the pathophysiology and genetics of EoE. [books.google.de]

Modern pathophysiology and treatment of esophageal diverticula. Langenbecks Arch Surg. 397(1):29-35. D'Journo XB, Ferraro P, Martin J, Chen LQ, Duranceau A. (2009 Aug). [review.ttu.edu.vn]

Staging of Alberto de Hoyos 2177 Less Common Malignant Tumors of the Diagnostic Investigation of Mediastinal 2195 The Use of Prosthetic Grafts to Replace 195 Poorly Differentiated Carcinoma of the Mediastinum 2411 2261 Benign and Malignant Neurogenic 2415 Pathophysiology [books.google.com]

Pathophysiology Pulsion type (most common) - true diverticulum - circumscribed sac or pouch created by herniation of esophageal mucosa through defect in surrounding muscularis, most commonly cranial to thoracic inlet or just in front of diaphragm. [vetstream.com]

Pathophysiology Esophageal diverticula are classified by location in the esophagus. Upper (pharyngoesophageal, Killian-Jamieson, or Zenker), middle, or lower (epiphrenic). [emedicine.medscape.com]

Prevention

Teach the patient methods to reduce symptoms, prevent malnutrition and weight loss, and improve sleep and rest. [medical-dictionary.thefreedictionary.com]

Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer. [en.wikipedia.org]

These preventive measures are very important in elderly patients who tend to take multiple medications particularly at bedtime. Chronic lesions caused by mucosal injury often lead to strictures. [clevelandclinicmeded.com]

The myotomy will prevent suture-line leak at the diverticulectomy site by relieving distal obstruction, in addition to decreasing diverticular recurrence and relieve symptoms of the underlying motility condition. [ctsnet.org]

Half of those with GERD respond to pharmacotherapy, the other half require additional surgical intervention with fundoplication to prevent long term complications such as Barrett’s esophagus and adenocarcinoma. [pedclerk.uchicago.edu]

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