A diverticulum is a pouch or sac that is created by herniation of a muscle wall. Zenker’s diverticula (ZD) are pouches that develop in the pharynx just above the upper esophageal sphincter. Food may become trapped there, causing difficulties in swallowing, bad breath, regurgitation, and irritation. ZD generally are categorized as small, intermediate, or large in size. They extend into the left side of the neck 90% of the time due to a slight convex shape of the esophagus to that side and the presence of a potential space there.
In Zenker’s diverticula, there is a splitting between muscles in the pharynx. Most often this split occurs in an area known as Killian triangle, although other areas are possible as well. The cause of Zenker’s diverticulum are not known, but theories include the following:
Zenker’s diverticula occur most often in northern European countries and those whose heritage is northern European, including the US, Canada and Australia. It is rare in Asia. It is one and a half times more common among men than women, and almost always occurs in older individuals.
The most dangerous symptom is aspiration, in which food or liquid enters the unprotected airway. If the diverticula spread into a major vessel, obstruction of the esophagus or trachea can occur. They can cause massive bleeding. Very rarely, squamous cell carcinoma within ZD occur.
A series of images of Zenker’s diverticulum on Vesalius.com
Treatment of Zenker’s Diverticulum