Zenker's Diverticulum

Zenker's diverticulum is a protrusion of pharyngeal mucosa (most commonly, a left posterolateral protrusion) that develops between the inferior pharyngeal constrictor and the cricopharyngeus. A predisposing factor is loss of elasticity of the upper esophageal sphincter resulting in restricted opening during swallowing. Symptoms of dysphagia and regurgitation tend to develop insiduously over years in middle-aged to elderly patients. Initial symptoms include vague oropharyngeal dysphagia with coughing or throat discomfort. As the diverticulum enlarges and retains food, there is marked halitosis, spontaneous regurgitation of undigested food, nocturnal choking, gurgling in the throat, or a protrusion in the neck. The diagnosis is best established by a barium esophagogram.