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Wan X, Liu H, Liu J, Peng Y. Diagnosis of bilateral pharyngoesophageal diverticula with using swallow contrast-enhanced ultrasound: a case report. Front Oncol 2024; 14:1351509. [PMID: 39206153 PMCID: PMC11349533 DOI: 10.3389/fonc.2024.1351509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Pharyngoesophageal diverticulum (PED) is a rare disease of the esophagus that is usually asymptomatic and often found incidentally during a thyroid ultrasound examination. Due to its anatomical location close to the thyroid, it is easily misdiagnosed as a thyroid nodule, which leads to unnecessary thyroid biopsies and surgical treatment. The occurrence of a single esophageal diverticula is common, while the existence of multiple diverticula is rare. Left side diverticula are more common than right sided ones, while bilateral occurrences are rarely reported. We report an extremely rare case of bilateral pharyngeal esophageal diverticula. The patient was a 55-year-old asymptomatic man who came to our hospital after thyroid nodules were identified in another hospital. Due to the extensive clinical experience of the ultrasound physician at our facility, the patient was suspected to have bilateral esophageal diverticula, which was confirmed by using swallow contrast-enhanced ultrasound (CEUS). Consequently, unnecessary thyroid treatments were avoided in this patient. This study shows that although bilateral pharyngeal diverticula are unusual, the possibility of their existence should be considered if nodules are located posterior to the bilateral thyroid glands and have suspicious imaging characteristics. Particular attention should be given to nodules located on the right side of the thyroid, which are sometimes overlooked easily due to their very low incidence. If real-time ultrasound cannot be used in making the diagnosis, PED can be further identified using swallowing CEUS to avoid unnecessary thyroid fine needle aspiration (FNA) and surgical treatment.
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Affiliation(s)
| | | | | | - Yulan Peng
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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2
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Alotaibi FZ, Lee GD, Lee YS. Concurrent Killian-Jamieson and Zenker's Diverticula. J Craniofac Surg 2023; 34:e630-e632. [PMID: 37357348 PMCID: PMC10521795 DOI: 10.1097/scs.0000000000009434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/11/2023] [Indexed: 06/27/2023] Open
Abstract
Pharyngoesophageal diverticula are rare causes of dysphagia. Zenker's diverticulum is the most common type, followed by Killian-Jamieson diverticulum. A 44-year-old male presented to our clinic with a longstanding history of dysphagia and globus sensation. Bilateral pharyngoesophageal diverticula were confirmed by imaging CT and esophagogastroscopy. He underwent transcervical resection, and a right Killian-Jamieson diverticulum was observed during surgery. The left diverticulum was found to originate above the cricopharyngeus muscle and was labeled as Zenker's diverticulum. Bilateral pharyngoesophageal diverticula are rare, and physicians should be aware of the variable clinical presentations and management options for pharyngoesophageal diverticula.
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Affiliation(s)
- Fahad Zarraq Alotaibi
- Department of Otolaryngology-Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Geun-Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Chaudhry IUH, Al Ghamdi AM, Al Qahtani Y, Algazal T, Razzaq B, Al Abdulhai MA, Al Fraih OM. A rare cause of dysphagia and simultaneous hoarseness of voice in the octogenarian: a Killian-Jamieson diverticulum, management, and review of literature. Ann Med Surg (Lond) 2023; 85:536-541. [PMID: 36923743 PMCID: PMC10010783 DOI: 10.1097/ms9.0000000000000259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/08/2023] [Indexed: 03/18/2023] Open
Abstract
An 82-year-old male presented with progressive dysphagia and simultaneous hoarseness of voice for the past 6 months. He had mitral valve repair and a permanent pacemaker for a heart block 5 years ago. A computed tomographic scan of the neck demonstrated a cervical esophageal diverticulum. Oral Gastrogrifin contrast study confirmed esophageal diverticulum in Killian-Jamieson space. Open surgical diverticulectomy was performed safely. Patient's dysphagia resolved immediately, and he regained his normal voice after 6 weeks. Introduction Killian-Jamieson's esophageal diverticulum is a rare form of pulsion diverticulum which originate through a muscular gap in the anterolateral wall of the esophagus, inferior to the cricopharyngeus muscle and superior to the circular and longitudinal muscle of the esophagus. Killian-Jamieson defined this area where the recurrent laryngeal nerve enters the pharynx, called Killian-Jamieson triangle. Ekberg and Nylander, in 1983, described an esophageal diverticulum in Killian-Jamieson space. The most common clinical manifestations in such patients are dysphagia, cough, epigastric pain, recurrent respiratory tract infections, and rarely hoarseness of voice. In symptomatic patients, surgical or endoscopic resection of the diverticulum is mandatory. We report this case in line with SCARE (Surgical CAse REport) criteria. Case Report An 82-year-old male presented to our outpatient clinic with a history of progressive dysphagia for solid food and hoarseness of voice for the last 6 months. He denied gastroesophageal reflux, cough, and shortness of breath. On examination of the neck, there was swelling on the left side but no tenderness or lymphadenopathy. Basic blood investigations, including complete blood count, liver, and renal panels, were normal. An echocardiogram showed mild impairment of left ventricle function and normally functioning mitral valve. Chest X-ray showed a pacemaker in position. Computed tomography scan of the neck showed esophageal diverticulum. Gastrogrifin contrast study showed esophageal Killian-Jamieson diverticulum (KJD). Discussion The acquired esophageal diverticulum is categorized into three types based on its anatomical location. Zenker's and Killian-Jamieson (pulsion diverticulum) in the proximal part, traction diverticulum in the middle part, due to pulling from fibrous adhesions following the lymph node infection and epiphanic pulsion type in the distal esophagus. Although the KJD and Zenker's diverticulum (ZD) arise close to each other in the pharyngoesophageal area, they are anatomically distinct. Although ZD and KJD have the same demographic features, they are more commonly found in older men (60-80 years) and women, respectively. The incidence of ZD is 0.01-0.11%, and KJD is 0.025% of the population. Rubesin et al. reported radiographic findings in 16 KJD cases. They found the majority of them were on the left side (72%), followed by 20% on the right side and 8% bilateral. Conclusion In conclusion, we report a rare case of dysphagia and simultaneous hoarseness of voice in an octogenarian due to KJD, who was treated with open diverticulectomy, and dysphagia resolved; he regained his voice back after 6 weeks. In our opinion, endoscopic surgery in such a patient with KJD can put recurrent laryngeal at risk of injury since an endoscopic approach operator cannot visualize and dissect away the recurrent laryngeal nerve, particularly when KJD already compresses it.
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Constantin A, Constantinoiu S, Achim F, Socea B, Costea DO, Predescu D. Esophageal diverticula: from diagnosis to therapeutic management-narrative review. J Thorac Dis 2023; 15:759-779. [PMID: 36910058 PMCID: PMC9992562 DOI: 10.21037/jtd-22-861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/12/2022] [Indexed: 02/04/2023]
Abstract
Background and Objective Esophageal diverticulum (ED) is a relatively rare condition, characterized by high etio- and pathophysiological versatility, with an uncommon clinical impact, consequently requiring a complete and complex diagnostic evaluation, so that the therapeutic decision is "appropriate" to a specific case. The aim of the paper is, therefore, a reassessment of the diagnostic possibilities underlying the establishment of the therapeutic protocol and the available therapeutic resources, making a review of the literature, and a non-statistical retrospective analysis of cases hospitalized and operated in a tertiary center. Methods Thus, classical investigations (upper digestive endoscopy, barium swallow) need to be correlated with complex, manometric, and imaging evaluations with direct implications in therapeutic management. Moreover, in the absence of a precise etiology, the operative indication needs to be established sparingly, with the imposition of the identification and interception of the pathophysiological mechanisms through the therapeutic gesture. Key Content and Findings The identification of the pathophysiological mechanisms is mandatory for the management of diverticular disease, the result obtained-restoring swallowing and comfort/good quality of life in the postoperative period-is directly related to the chosen therapeutic procedure. In addition, management appears to be a difficult goal in the context of the low incidence of ED but also of the results that emphasize important differences in the reports in the medical literature. Although ED is a benign condition, surgical techniques are demanding, impacted by significant morbidity and mortality. The causes of these results are multiple: possible localizations anywhere in the esophagus, diverticulum size/volume from a few millimeters to an impressive one, over 10-12 cm, metabolic impact in direct relation to the alteration swallowing, numerous diverticular complications but, perhaps most importantly, alteration of the quality of the diverticular wall by inflammatory phenomena, with an impact on the quality of the suture. Conclusions The accumulation of cases in a tertiary profile center, with volume/hospital, respectively volume/surgeon + gastroenterologist could be a solution in improving the results. One consequence would be the identification of alternative solutions to open surgical techniques, a series of minimally invasive or endoscopic variants can refine these results.
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Affiliation(s)
- Adrian Constantin
- General and Esophageal Clinic, Sf. Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Silviu Constantinoiu
- General and Esophageal Clinic, Sf. Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Florin Achim
- General and Esophageal Clinic, Sf. Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, Sf. Pantelimon Emergency Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniel Ovidiu Costea
- Department II of Surgery, Emergency Hospital, Ovidius University of Medicine, Constanta, Romania
| | - Dragos Predescu
- General and Esophageal Clinic, Sf. Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Watanabe Y, Taniyama Y, Koseki K, Ishida H, Ozawa Y, Okamoto H, Sato C, Unno M, Kamei T. Distinguishing Killian-Jamieson diverticulum from Zenker's diverticulum. Surg Case Rep 2023; 9:21. [PMID: 36759360 PMCID: PMC9911565 DOI: 10.1186/s40792-023-01599-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Killian-Jamieson diverticulum, which is a relatively rare pharyngoesophageal diverticulum, is difficult to distinguish from Zenker's diverticulum. Because major points of the relevant surgical procedures for these two entities differ, it is important to make an accurate diagnosis. We herein report a case of Killian-Jamieson diverticulum initially diagnosed as Zenker's diverticulum. CASE PRESENTATION A 56-year-old man complaining of discomfort during swallowing was diagnosed with pharyngoesophageal diverticulum. He was initially diagnosed with Zenker's diverticulum before surgery, but the diverticulum actually arose from the left side of the esophageal wall, at the level of the cricoid cartilage and below the cricopharyngeal muscle. We therefore ultimately diagnosed this case as Killian-Jamieson diverticulum during surgery, and were able to preserve the muscle above the diverticulum, which would normally have to be cut when treating a case of Zenker's diverticulum. CONCLUSION To make an accurate diagnosis, clinical and surgical findings are important to consider, including the location of the diverticulum and the relationship between the diverticula and cricopharyngeal muscles or between the diverticula, thyroid cartilage and cricoid cartilage.
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Affiliation(s)
- Yuki Watanabe
- Department of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.
| | - Yusuke Taniyama
- grid.412757.20000 0004 0641 778XDepartment of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi 980-8574 Japan
| | - Ken Koseki
- grid.412757.20000 0004 0641 778XDepartment of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi 980-8574 Japan
| | - Hirotaka Ishida
- grid.412757.20000 0004 0641 778XDepartment of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi 980-8574 Japan
| | - Yohei Ozawa
- grid.412757.20000 0004 0641 778XDepartment of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi 980-8574 Japan
| | - Hiroshi Okamoto
- grid.412757.20000 0004 0641 778XDepartment of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi 980-8574 Japan
| | - Chiaki Sato
- grid.412757.20000 0004 0641 778XDepartment of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi 980-8574 Japan
| | - Michiaki Unno
- grid.412757.20000 0004 0641 778XDepartment of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi 980-8574 Japan
| | - Takashi Kamei
- grid.412757.20000 0004 0641 778XDepartment of Surgery, Tohoku University Hospital, 1-1, Seiryo-Tyo, Aoba-Ku, Sendai, Miyagi 980-8574 Japan
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Watanabe Y, Taniyama Y, Koseki K, Ishida H, Ozawa Y, Okamoto H, Sato C, Unno M, Kamei T. Distinguishing Killian–Jamieson diverticulum from Zenker’s diverticulum. Surg Case Rep 2023; 9:21. [DOI: doi.org/10.1186/s40792-023-01599-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/24/2023] [Indexed: 09/03/2023] Open
Abstract
Abstract
Background
Killian–Jamieson diverticulum, which is a relatively rare pharyngoesophageal diverticulum, is difficult to distinguish from Zenker’s diverticulum. Because major points of the relevant surgical procedures for these two entities differ, it is important to make an accurate diagnosis. We herein report a case of Killian–Jamieson diverticulum initially diagnosed as Zenker’s diverticulum.
Case presentation
A 56-year-old man complaining of discomfort during swallowing was diagnosed with pharyngoesophageal diverticulum. He was initially diagnosed with Zenker’s diverticulum before surgery, but the diverticulum actually arose from the left side of the esophageal wall, at the level of the cricoid cartilage and below the cricopharyngeal muscle. We therefore ultimately diagnosed this case as Killian–Jamieson diverticulum during surgery, and were able to preserve the muscle above the diverticulum, which would normally have to be cut when treating a case of Zenker’s diverticulum.
Conclusion
To make an accurate diagnosis, clinical and surgical findings are important to consider, including the location of the diverticulum and the relationship between the diverticula and cricopharyngeal muscles or between the diverticula, thyroid cartilage and cricoid cartilage.
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7
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Manjunath MK, Devasamudra CR. Killian-Jamieson Diverticulum-A Rare Cause of Dysphagia in an Adult Male. Indian J Otolaryngol Head Neck Surg 2022; 74:1882-1885. [PMID: 36452558 PMCID: PMC9702236 DOI: 10.1007/s12070-020-01885-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022] Open
Abstract
Killian Jamieson diverticulum is a rare diverticulum of the esophagus that out pouches through the Killian Jamieson's dehiscence. They are relatively rare compared to Zenker's diverticula, although both present similarly. However, both needs to be distinguished separately and treated accordingly given their anatomic variations.
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Affiliation(s)
- M. K. Manjunath
- Columbia Asia Referral Hospital, Brigade gateway, Malleshwaram West, Yeshwanthpur, Bengaluru, 560055 India
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8
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Chen X, Liu JF, Gu CJ, Ding SJ, Zhou SX, Chen XY, Ni XJ. Ultrasonographic characteristics of Killian-Jamieson diverticula. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:527-532. [PMID: 33786835 DOI: 10.1002/jcu.23011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE A Killian-Jamieson diverticulum (KJD) may be mistaken for a thyroid nodule on ultrasound (US). The purpose of this retrospective study was to search for specific US features that would help differentiate between KJD and thyroid nodules. METHODS A total of 12 patients with KJD who had undergone an US examination of the neck were identified. The size, shape, boundary, echopattern, location, color flow signals on color Doppler US of KJD and the relationship between the lesion and esophageal wall were analyzed. The change of size, shape and internal echotexture were also observed when the lesion was compressed with the probe and when the patient was asked to drink water. RESULTS All KJD were confirmed by barium esophagography. All KJD were posterior to the left thyroid lobe on US, and were associated with a semicircular hypoechoic anterior wall. The internal echotexture was heterogeneous. In eight cases, the connection to the esophageal wall was seen. When compressing with the US probe or when the patients swallowed water, the size, shape or internal echotexture of the lesion changed. CONCLUSION The specific criteria for US diagnosis of KJD included the connection to the esophageal wall and the fact that the internal echotexture, shape and size of KJD changed in real-time when the patient swallowed water or when the lesion was compressed with the transducer.
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Affiliation(s)
- Xi Chen
- Department of Medical Ultrasound, Affiliated Hospital to Nantong University, Nantong, China
| | - Jie-Fu Liu
- Department of Medical Ultrasound, Affiliated Hospital to Nantong University, Nantong, China
| | - Chang-Jiang Gu
- Department of Thyroid and Breast Surgery, Affiliated Hospital to Nantong University, Nantong, China
| | - Su-Jun Ding
- Department of Medical Ultrasound, Affiliated Hospital to Nantong University, Nantong, China
| | - Shui-Xiu Zhou
- Department of Medical Ultrasound, Affiliated Hospital to Nantong University, Nantong, China
| | - Xiao-Yang Chen
- Department of Medical Ultrasound, Affiliated Hospital to Nantong University, Nantong, China
| | - Xue-Jun Ni
- Department of Medical Ultrasound, Affiliated Hospital to Nantong University, Nantong, China
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Tagliaferri A. The role of fluoroscopy in diagnosing a Killian-Jamieson diverticulum. J Community Hosp Intern Med Perspect 2021; 11:228-234. [PMID: 33889326 PMCID: PMC8043607 DOI: 10.1080/20009666.2021.1893144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A Killian–Jamieson diverticulum is a ‘false’ diverticulum on the lateral side of the proximal cervical esophagus. They are much rarer than Zenker diverticula and can be difficult to diagnose. They are best visualized using fluoroscopy studies, however, the workup for patients admitted with dysphagia can be sometimes extensive and unnecessary, leading to costly hospital stays, longer admissions and exposure to excessive radiation. Herein, we present a patient previously diagnosed with a Killian Jamieson diverticulum, who presented with worsening dysphagia, odynophagia and neck swelling, and was found to have an unusual inferior extension of the diverticulum. This paper will recognize the role of fluoroscopy in diagnosing diverticula and identifying causes of dysphagia, and to also recognize the use of American College of Radiology ‘ACR’ Appropriateness Criteria to minimize unnecessary studies.
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Affiliation(s)
- A Tagliaferri
- Department of Radiology, SKMC at Thomas Jefferson University, Philadelphia, PA, USA
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Saisho K, Matono S, Tanaka T, Mori N, Hino H, Fujisaki M, Nakagawa M, Fujita F, Akagi Y. Surgery for Killian-Jamieson diverticulum: a report of two cases. Surg Case Rep 2020; 6:17. [PMID: 31933008 PMCID: PMC6957605 DOI: 10.1186/s40792-020-0789-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Killian-Jamieson diverticulum (KJD) is a rare diverticulum arising from a muscular gap in the anterolateral wall of the proximal cervical esophagus. The first choice of treatment for KJD remains controversial due to its rare incidence. Here, we report two cases of KJD for which we performed different surgery: diverticulectomy in one case and diverticulopexy in the other. CASE PRESENTATION Case 1 involved a 58-year-old woman presenting progressive pharyngeal discomfort for the past year. She was diagnosed as KJD using endoscopic and radiographic findings. She underwent diverticulectomy with cricopharyngeal and proximal esophageal myotomy. Staple line leakage developed at 1 month after surgery and was successfully treated conservatively. At 5 months after surgery, she was asymptomatic. Case 2 involved a 77-year-old woman presenting dysphagia for the past 2 years. She had a history of bilateral breast cancer and had hypertension, asthma, and osteoporosis. Taking her age and medical history into account, we selected diverticulopexy with cricopharyngeal and proximal esophageal myotomy. The postoperative course was uneventful. At 2 years after surgery, she remained free of dysphagia. CONCLUSION The first choice of surgery for KJD is diverticulectomy. In a high-risk patient, diverticulopexy is a reasonable treatment. We recommend the addition of myotomy as a part of any surgical treatment.
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Affiliation(s)
- Kohei Saisho
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
| | - Satoru Matono
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
| | - Toshiaki Tanaka
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
| | - Naoki Mori
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
| | - Haruhiro Hino
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
| | - Masahiro Fujisaki
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
| | - Masashi Nakagawa
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan
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Presentation and Management of Killian Jamieson Diverticulum: A Comprehensive Literature Review. Ann Otol Rhinol Laryngol 2019; 129:394-400. [DOI: 10.1177/0003489419887403] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To examine the clinical presentation, diagnostic evaluation, and management of Killian–Jamieson diverticula (KJD) through literature review. Methods: A comprehensive literature review was conducted through December 2018 using keywords Killian–Jamieson diverticula/diverticulum. Data extracted included clinical presentation, imaging characteristics, surgical management, and postoperative care. Sources: PubMed and Google Scholar. Results: Sixty-eight cases of KJD in 59 reports (29M:39F; median 58 years old) were identified for review. The most common presentation was dysphagia (n = 39), suspected thyroid nodule (n = 24) and globus (n = 14). The majority of KJD (n = 51) occur on the left, with rare reports of right side (n = 11) and bilateral (n = 5) presentation. Thirty-two cases describe surgical management: 22 utilizing a transcervical approach, with (n = 13) or without (n = 9) cricopharyngeal myotomy; and 10 reported endoscopic surgery. Diverticula managed transcervically averaged 3.8 cm in size in comparison to average 2.8 cm in the endoscopic group. Time to diet initiation after transcervical surgery averaged 4 days versus 2 days after endoscopic surgery. Complications were reported in 2/68 cases; both were diverticula recurrence after endoscopic surgery. Conclusion: Killian–Jamieson diverticula is a rare diagnosis that should be considered in the evaluation of dysphagia, globus, and also suspected thyroid nodule. When patient symptoms warrant intervention, a transcervical approach, with or without cricopharyngeal myotomy, is most commonly utilized. In recent years, an endoscopic approach has been presented as an alternative for smaller diverticula. Further understanding of the optimal treatment and postoperative management for KJD requires larger cohorts. Level of Evidence: 4
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Jeismann VB, Bianchi ET, Szachnowicz S, Seguro FCBDC, Tustumi F, Duarte AF, Sallum RAA, Cecconello I. Surgical treatment of Killian-Jamieson diverticulum: A case report and literature review. Clin Case Rep 2019; 7:1374-1377. [PMID: 31360491 PMCID: PMC6637344 DOI: 10.1002/ccr3.2249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/30/2019] [Accepted: 05/15/2019] [Indexed: 12/04/2022] Open
Abstract
This study describes a patient with symptomatic Killian-Jamieson, a rare entity, successfully treated by cervical approach with diverticulum resection and esophagomyotomy.
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Affiliation(s)
- Vagner Birk Jeismann
- Hospital das Clínicas, Faculty of MedicineUniversity of São PauloCerqueira CesarSao PauloBrazil
| | - Edno Tales Bianchi
- Hospital das Clínicas, Faculty of MedicineUniversity of São PauloCerqueira CesarSao PauloBrazil
| | - Sérgio Szachnowicz
- Hospital das Clínicas, Faculty of MedicineUniversity of São PauloCerqueira CesarSao PauloBrazil
| | | | - Francisco Tustumi
- Hospital das Clínicas, Faculty of MedicineUniversity of São PauloCerqueira CesarSao PauloBrazil
| | - Andre Fonseca Duarte
- Hospital das Clínicas, Faculty of MedicineUniversity of São PauloCerqueira CesarSao PauloBrazil
| | | | - Ivan Cecconello
- Hospital das Clínicas, Faculty of MedicineUniversity of São PauloCerqueira CesarSao PauloBrazil
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Yun PJ, Huang HK, Chang H, Lee SC, Huang TW. Endoscopic diverticulotomy with a stapler can be an effective and safe treatment for Killian-Jamieson diverticulum. J Thorac Dis 2017; 9:E787-E791. [PMID: 29221344 DOI: 10.21037/jtd.2017.08.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Killian-Jamieson diverticulum (KJD) is a rarely encountered esophageal diverticulum which attributes to several symptoms. Clinically, KJD should be differentiated from the most common type of esophageal herniation, i.e., Zenker's diverticulum (ZD). The two diverticula may present in a similar fashion, and treatments have evolved from transcervical to a minimally invasive endoscopic approach in recent years. We present a case of an 88-year-old male with symptomatic esophageal diverticulum. Barium swallow esophagogram and flexible esophagoscopy demonstrated a large KJD with food debris retention. Endoscopic diverticulotomy using a stapler was performed successfully without injury to the recurrent laryngeal nerve (RLN). A literature review and discussion concerning etiology, clinical presentations, and radiographic characteristics of KJD was conducted, and comparison between open and endoscopic method for esophageal diverticulum was also carried out.
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Affiliation(s)
- Po-Jen Yun
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Hsu-Kai Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Hung Chang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Shih-Chun Lee
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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Simultaneously occurring Zenker's diverticulum and Killian-Jamieson diverticulum: case report and literature review. The Journal of Laryngology & Otology 2017. [PMID: 28625183 DOI: 10.1017/s0022215117001268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pharyngoesophageal diverticula have many subtypes, with Zenker's diverticulum being the most common. First described in 1983, a Killian-Jamieson diverticulum is an outpouching in the anterolateral wall at the pharyngoesophageal junction. This is located inferiorly to the cricopharyngeus muscle, unlike Zenker's diverticula which occur superiorly. Killian-Jamieson diverticula are rare and are commonly misdiagnosed as Zenker's diverticula. Less than 30 reports of Killian-Jamieson diverticula have been described in the literature. CASE REPORT A 69-year-old man presented with a 2-year symptomatic history, and was found to have simultaneous Zenker's diverticulum and Killian-Jamieson diverticulum. He was treated successfully with open surgical excision of both pouches. CONCLUSION Zenker's diverticulum and Killian-Jamieson diverticulum are diagnosed using radiological studies and endoscopy. Their differentiation is important, as surgical management differs. This paper reviews the literature on Killian-Jamieson diverticula and the management options available.
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15
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Leite TF, Chagas CAA, Pires LAS, Cisne R, Babinski MA. Pharyngoesophageal Obstruction on the Killian-Laimer Triangle by Zenker's Diverticulum: Case Report and Clinical Significance. Gastroenterology Res 2016; 8:316-319. [PMID: 27785316 PMCID: PMC5051033 DOI: 10.14740/gr696w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/18/2022] Open
Abstract
Zenker’s diverticulum is a form of esophageal and pharyngeal obstruction located at the Killian-Laimer triangle. It is relatively common in elderly man (seventh or eighth decade of life), and its pathophysiology is not completely understood, albeit theories regarding dysfunction of the upper esophageal sphincter were reported. The main symptoms are dysphagia and odynophagia, but it can complicate to aspiration and perforation of the pharyngeal pouch; also, it can be asymptomatic. Diagnosis is provided through a barium esophagogram. Treatment can be performed through endoscopic surgery, diverticulopexy and myotomy of the cricopharyngeus muscle, although there is no consensus among surgeons regarding the treatment of choice. We report a case of pharyngeal obstruction due to Zenker’s diverticulum which caused massive weight loss in a 76-year-old male.
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Affiliation(s)
- Tulio F Leite
- Department General Surgery, Santa Casa Hospital, Ribeirao Preto, SP, Brazil; Department of Morphology, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
| | - Carlos A A Chagas
- Department of Morphology, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
| | - Lucas A S Pires
- Department of Morphology, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
| | - Rafael Cisne
- Department of Morphology, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
| | - Marcio A Babinski
- Department of Morphology, Biomedical Institute, Fluminense Federal University, Niteroi, RJ, Brazil
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16
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Cao L, Ge J, Zhao D, Lei S. Killian-Jamieson diverticulum mimicking a calcified thyroid nodule on ultrasonography: A case report and literature review. Oncol Lett 2016; 12:2742-2745. [PMID: 27698850 DOI: 10.3892/ol.2016.4984] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/01/2016] [Indexed: 11/05/2022] Open
Abstract
As a rare hypopharyngeal diverticulum, Killian-Jamieson diverticulum (KJD) is usually incidentally detected, small, asymptomatic and likely to be misdiagnosed as a thyroid nodule. In order to avoid unnecessary treatments resulting from misdiagnosis, principles to distinguish between esophageal diverticula and thyroid nodules should be noted clearly. The current study presents a case of an asymptomatic unilateral KJD that mimicked a calcified thyroid nodule. In the current case, a 40-year-old man presented with a 'suspected malignant thyroid nodule' in the left thyroid gland, and underwent left thyroid lobectomy and a neck exploration. However, no visible 'suspected tumor', but a sac protruding from the left anterolateral wall of the cervical esophagus, was observed during the surgery. A swallow test on ultrasonography (US) in combination with pharyngoesophagography was then performed, which confirmed the diagnosis. The patient recovered well during the 3-month follow-up after the operation. The present study indicates that real-time US and pharyngoesophagography are important techniques to distinguish a KJD from a thyroid nodule so that unnecessary surgical intervention can be avoided.
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Affiliation(s)
- Li Cao
- Department of Breast Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Junna Ge
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Donghui Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Shangtong Lei
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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17
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Rigid endoscopic LASER diverticulotomy for lateral pharyngoesophageal diverticuli: cases presentation and discussion. Eur Arch Otorhinolaryngol 2016; 273:4637-4642. [PMID: 27149873 DOI: 10.1007/s00405-016-4080-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
Killian-Jamieson diverticulum (KJD) is a rare cervical esophageal abnormality. Transcervical approach has been the main treatment modality to prevent recurrent laryngeal nerve (RLN) injury. We presented two cases of patients confirmed with KJD and were managed successfully under rigid endoscope. The new technique and idea were described in detail. Under rigid laryngoscope, the septum between the true esophagus lumen and diverticulum can be exposed clearly. A microscope equipped with CO2 LASER system offered precise and focused point cutting energy to the septum. Several efforts were applied to prevent RLN injury in the cases descriptions. We use transnasal esophagoscope and eating assessment tool (EAT-10) for anatomic and functional result evaluation. Much improved symptoms of dysphagia and intact RLN function were observed. Under the assist of rigid laryngoscope and point-cutting CO2 LASER, KJD diverticulotomy could be performed safely with little complication for patients refusing transcervical route.
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18
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Wang L, Cao J, Ding P, Xin Y, Dai HP. Killian-Jamieson diverticulum with severe stenosis of the esophagus: A case report. Shijie Huaren Xiaohua Zazhi 2015; 23:1695-1698. [DOI: 10.11569/wcjd.v23.i10.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pharyngo-esophageal diverticula (also called pharyngeal bursa) consist of two main types, Zenker's diverticulum and Killian-Jamieson's diverticulum. In this paper, we report a case of Killian-Jamieson's diverticulum with esophageal stenosis. We reviewed the related literature and investigate the characteristics of symptoms, imaging examinations, history and the course of the disease. By comparing with Zenker's diverticulum, we further discuss the pathogenesis, etiological and risk factors, symptoms, diagnosis and treatment of this rare disease.
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19
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Siow SL, Mahendran HA, Hardin M. Transcervical diverticulectomy for Killian-Jamieson diverticulum. Asian J Surg 2015; 40:324-328. [PMID: 25779884 DOI: 10.1016/j.asjsur.2015.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/18/2014] [Accepted: 01/15/2015] [Indexed: 10/23/2022] Open
Abstract
Surgery for Killian-Jamieson diverticulum of the esophagus is scarcely reported in the literature owing to the rarity of this entity. This is a case report of such a diverticulum and a description of the transcervical diverticulectomy that we performed on a 49-year-old lady. The patient was investigated for symptoms of gastroesophageal reflux disease and was diagnosed with a left-sided Killian-Jamieson diverticulum.
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Affiliation(s)
- Sze Li Siow
- Department of Surgery, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia.
| | - Hans Alexander Mahendran
- Department of Surgery, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Mark Hardin
- Department of Surgery, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
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20
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Andrews K, Branski RC, Amin MR. Progressive dysphagia and cough. Dysphagia 2013; 28:595-7. [PMID: 23892720 DOI: 10.1007/s00455-013-9480-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Kenneth Andrews
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, 345 East 37th Street, Suite 306, New York, NY, 10016, USA
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21
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Scheeren B, Mello RJKD, Gonçalves CM, Maciel AC. Bilateral Killian-Jamieson diverticula demonstrated by videofluoroscopic swallowing study: case report. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000300017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The authors report the case of a 56-year-old male patient complaining of dysphagia for solids and food impaction, submitted to videofluoroscopic swallowing study that demonstrated the presence of two esophageal diverticula. The videofluoroscopic swallowing study was critical in the identification and diagnosis of the diverticula, an esophageal cause of dysphagia.
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Affiliation(s)
| | | | | | - Antonio Carlos Maciel
- Hospital Santa Clara, Brazil; Hospital São Francisco da Santa Casa de Misericórdia de Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Brazil
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