ESOPHAGEAL DIVERTICULA:

Most of the esophageal diverticulum are acquired; they can be 'pulsion' or 'traction'. 

• Pulsion diverticula are those where intra-luminal pressure of the esophagus remains high for prolonged periods due to distal obstruction. This leads to the outpouching of mucosa through a weak point on its wall. 

• Traction diverticula are those in which there is paraesophageal granulomatous inflammation leading to fibrosis which exerts a pull on the wall of esophagus leading to diverticula formation.

1. PHARYNGEAL POUCH: (Zenker's Diverticulum)

It is not a real esophageal diverticulum. It is diverticulum of the mucosa of the pharynx, just

above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a false diverticulum (not involving all layers of the esophageal wall. It occurs through Killian's

dehiscence in the pharynx which is a weak area between thyro-pharyngeous and crico-pharyngeous muscle. It is pulsion crico-pharyngeous diverticulum usually caused by increase in the tonicity of crico-pharyngeous but true etiology is unknown. It usually occurs after the age of 60

years.

Clinical features:

While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as dysphagia, and sense of a lump in the neck; moreover, it may fill up with food, causing regurgitation, cough (as some food may be regurgitated into the airways), halitosis (smelly breath, as stagnant food is digested by microorganisms), potential infection of the

pharyngeal areas due to food stuck, and involuntary gurgling noises when swallowing. It

rarely, if ever, causes any pain, Cervical webs are seen associated in 50% of patients with this

condition.

Diagnosis:

• Barium Swallow

• Endoscopy:

Treatment:

Pouch can be excised endoscopically or externally if causing symptoms.

2. MIDESOPHAGEAL DIVERTICULA:

Mid-esophageal diverticula are usually traction diverticulum caused by granulomatous inflammation around the esophagus. They are usually incidental finding in barium study and

require no treatment.

3. EPIPHRENIC DIVERTICULA:

Also called supradiaphragmatic diverticula, They usually occur within a distal 10cm of a thoracic esophagus. They are pulsion diverticulum and arise due to esophageal motility disorder or by mechanical distal esophageal obstruction. May present with dysphagia and regurgitation and are diagnosed on barium study. Large diverticulum >3cm and should be excised and myotomy

should also be performed to relieve the cause of diverticulum.