HYPOPHARYNGEAL (PHARYNGOESOPHAGEAL) “ZENKER’S” PULSION DIVERTICULUM
FIRST DESCRIBED BY LUDLOW 1769, CLARIFIED BY ZENKER 1874
JUST SUP TO TRANSVERSE FIBERS OF THE CRICOPHARYNGEUS (CP)—IN INF ASPECT OF KILLIAN’S DEHISSANCE (DEHISSANCE IN INF CONSTRICTORS)
OFTEN COINCIDE WITH REFLUX—-HIATAL HERNIA—LEADS TO CP SPASM AND PULSION DIVERTICULUM
USUALLY LEFT OF MIDLINE ON POST HYPOPHARYNGEAL WALL
( VS LATERAL HYPOPHARYNGEAL DIVERTICULUM [CAN BE B], EPIPHRENIC PULSION DIVERTICULUM USUALLY RIGHT OF MIDLINE JUST OVER LES, MIDTHORACIC “TRACTION” DIVERTICULUM IS USUALLY LEFT OF MIDLINE AND ASSOC. WITH HILAR ADENOPATHY[BRONCHOGENIC CA, SARCOID, TB])
60% PTS > 60 HAVE SOME DEGREE OF IT
GRADUAL ONSET OF “TRANSFER” DYSPHAGIA
GLOBUS SENSATION AT SUPRASTERNAL NOTCH
REGURGITATION AFTER MEALS
ASPIRATION—PNEUMONIA
HALITOSIS
Dx: MOD BARIUM SWALLOW, FLEX FIBEROPTIC NASOPHARYNGOSCOPY WITH REVERSE MUELLER MANUEVER
Rx: OBSERVATION, EXTERNAL APPROACH: EXCISION, PEXY, CP MYOTOMY (HIGH RISK TO RLN), ENDOSCOPIC CP MYOTOMY “DOHLMAN PROCEDURE” WITH KTP LASER OR ENDOSCOPIC STAPLING WITH US SURGICAL ENDOSCOPIC IGA STAPLER—MAY HAVE TO DEAL WITH APEX OF WOUND WITH SUTURES
DOHLMAN PROCEDURE
HAVE PRE-OP CXR AND EKG
KEFZOL OCOR?
LASER WRAP TUBE—-EYEWEAR
GET KTP LASER UP—–CONTINUOUS MODE AT 6 WATTS
START WITH DL
STEROIDS AND ABX MAY MASK AN EARLY MEDIASTINITIS—–PROBABLY AVOID
HAVE KTP OR CO2 LASER UP
PUT IN NG TUBE INTRA-OP—MAY DO INITIALLY OR CONFIRM WITH ESOPHAGOSCOPE
KEEP NPO
GET POST OP CXR (NEED NOT BE ACUTE)—LOOKING FOR PNEUMOMEDIASTINIM ECT..
WATCH POST OP VS CAREFULLY (TEMP, HR, RR) PLEURODYNIA, ECT….