Zenker Diverticulum in an Older Woman

For 2 months, food particles had been regurgitating into a 72-year-old woman's throat after meals. Barium esophagography revealed a Zenker, or pharyngoesophageal, diverticulum (Figure A, white arrow). Figure B depicts the diverticulum (white arrow) and particulate matter (black arrow) that had been regurgitated into the hypopharynx.

Zenker diverticulum is the most common of esophageal diverticula, write Drs Robert P. Blereau, MD and Timothy J. Haley of Morgan City, La. The condition generally occurs in persons who are between the ages of 30 and 50 years; thus, it is believed to be an acquired disorder. The diverticulum arises at the Killian triangle, a point of potential weakness at the posterior pharyngoesophageal junction.

Symptoms of Zenker diverticulum include cervical dysphagia, effortless regurgitation of undigested food particles, choking, and recurrent aspiration. As in this case, esophagography establishes the diagnosis.

Surgical intervention generally is indicated to prevent complications. This patient declined surgery. She was treated with metoclopramide, a prokinetic drug taken before meals; her condition improved significantly.