Overview
Also known as Zenker’s diverticulum, a pharyngeal pouch is a diverticulum (outpouching) of the pharyngeal mucosa through Killian’s dehiscence, which is superior to the cricopharyngeus muscle and inferior to the thyropharyngeus muscle.
Killian’s dehiscence is where there is least resistance and it is thought that pharyngeal pouches develop due to herniation secondary to increased pressures in the distal pharynx. These pressure increases can occur due to uncoordinated swallowing and impaired relaxation of the surrounding muscles.
Epidemiology
- Most cases are seen in patients >70 years
- Cases are around 5 times more common in men
Presentation
The main presenting complaint is dysphagia. As always, dysphagia is a red-flag symptom that always raises suspicion of malignancy. Other features may be:
- Regurgitation
- Aspiration
- Neck swelling:
- This tends to gurgle when palpated
- Halitosis
- Due to food decaying in the pouch
- Chronic cough
Investigation
- Oesophagogastroduodenoscopy:
- To rule out malignancy
- There may be a risk of pouch perforation
- Barium swallow:
- The gold-standard test
- Shows a pool of contrast within the pouch
- Serial x-rays are taken and since the barium pools in the pouch, it remains in situ between each film
Management
Patients are managed under Ear, Nose, and Throat (ENT) and management typically involves surgery or endoscopic stapling.
Complications
- Aspiration and pneumonia
- Development of cancer
