Zenker's diverticulum in childhood: a new case

Congenital esophageal diverticulum - a case report and review of literature

Zenker's Diverticulum (ZD) is a false diverticulum located in the posterior esophagus between the cricopharyngeus and inferior constrictor. Few cases have been reported in the pediatric population. Congenital esophageal diverticulum is commonly associated with additional esophageal anatomical deformities or iatrogenic injury in the early post-natal period. 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. Flexible bronchoscopy performed under sedation revealed a retropharyngeal mass protruding towards the epiglottis resulting in upper airway obstruction. Esophogram demonstrated upper esophageal diverticulum. Patient underwent left neck dissection with cervical myotomy from the cricopharyngeus to the level of the thoracic inlet. A postoperative repeat esophogram illustrated resolution of the diverticulum. Currently, the patient is 9 months postoperative and is tolerating feeds by mouth, gaining weight and has no pulmonary symptoms. There have been a few reports of ZD in children occurring in combination with anatomical abnormalities or esophageal manipulation. This case is one of the youngest reported and occurs in a patient without any previous manipulation of the esophagus. This condition is exceedingly rare but should be included in the differential diagnosis for both pharyngoesophageal and tracheal symptoms.

Endoscopic treatment of pharyngo-esophageal diverticulum in child

Pharyngo-esophageal diverticula are extremely rare among children. Treatment in adults usually consists of endoscopic resection of the crico-pharyngeal muscle but application of this surgical procedure in children has not been reported before. We report the case of a 5-year-old boy whose recurrent pulmonary infection and chronic low weight led to diagnosis of a pharyngeal diverticulum. The diverticulum was removed by endoscopic CO(2) laser surgery. No relapse occurred during the 4-year follow-up period after surgery.

Acquired pharyngoesophageal diverticulum in childhood

Pharyngoesophageal diverticula are rare in the paediatric population. Most reported cases in children are congenital in nature. We present a unique acquired case of diverticulum in childhood, together with radiographic evidence of this pathology.

Esophageal stricture with a pseudodiverticulum caused by the unrecognized ingestion of a small foreign body in a child: report of a case

A 2-year-old boy with a long history of vomiting, dysphagia, and weight loss was found to have a rigid stricture in the proximal esophagus. We performed esophageal repair using a Livaditis circular myotomy technique. The removed section of esophagus contained the inflammatory stricture with a pseudodiverticulum, caused by the unrecognized ingestion of a small, hard plastic sticker.

Cricopharyngeal myotomy in the treatment of Zenker's diverticulum

BACKGROUND

Transection of the cricopharyngeus muscle supposedly is of crucial therapeutic importance, because of its hypothesized pathogenic role in Zenker's diverticulum (ZD). This retrospective, nonrandomized study evaluates the outcomes of surgical therapy, with reference to cricopharyngeal myotomy (CM).

STUDY DESIGN

Seventy-nine patients underwent diverticulectomy from 1985 to 1999. Group A (n = 47; men:women, 29:18; mean age +/- SD: 69 +/- 12 [range 35 to 87] years) underwent CM because of clearly discernible hypertrophic transverse fibers. In group B (n = 32; men:women, 22:10; mean age +/- SD 68 +/- 13 [range 36 to 95] years), without such transverse fibers, no CM was carried out. Dysphagia, regurgitation, and diverticular radiomorphology were classified according to ordinal scales. Diverticular volumes were calculated from barium swallows. Postoperative symptoms and outcomes were evaluated by questionnaires sent to the patients.

RESULTS

The two groups did not differ significantly in severity of preoperative dysphagia and regurgitation, radiomorphology, or median diverticular volume. Both groups experienced postoperative alleviation of symptoms (p < 0.001), persisting slightly in 11 of 47 (23%) group A and 4 of 32 (13%) group B patients (p > 0.05). Of these, seven group A (64%) patients and three group B patients (75%) had additional upper gastrointestinal tract (GIT) diseases. Recurrent diverticula occurred in one patient and postoperative complications in five patients per group (p > 0.05). Diverticular volume and upper GIT comorbidities, but not CM, were significant risk factors for persistent symptoms in the multivariate analysis.

CONCLUSIONS

CM has no significant influence on postoperative results, if carried out depending on the anatomic state and configuration of the cricopharyngeus muscle. This is suggested by the favorable outcomes of patients, with persistent symptoms being caused by factors other than CM.