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Zenker's diverticulum

Chris J J Mulder, MD
Foke van Delft, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Zenker's diverticulum is a sac-like outpouching of the mucosa and submucosa through Killian's triangle, an area of muscular weakness between the transverse fibers of the m. cricopharyngeus and the oblique fibers of the lower inferior constrictor muscle. The annual incidence of symptomatic Zenker's diverticulum in the United Kingdom has been estimated at 2 per 100,000 per year [1]. Symptomatic Zenker's diverticula are male predominant (ratio 1.5) and typically seen in middle-aged adults and older adults in their seventh or eighth decade of life. The occurrence of Zenker's diverticula shows geographical variation and has been described more frequently in Northern Europe, North America, and Australia than in Southern Europe, Japan, or Indonesia [2]. The pharyngoesophageal diverticulum was first described by Ludlow in 1767 [3]. Zenker and von Ziemssen subsequently reviewed the world literature in 1877. Since then, this kind of diverticulum has been called Zenker's diverticulum [4].

Zenker's diverticulum is defined as a posterior "false" diverticulum that has a neck proximal to the cricopharyngeal muscle (image 1). Most authors consider it among the other types of esophageal diverticula, all of which are outpouchings of one or more layers of the esophageal wall. "True" diverticula contain all layers of the intestinal wall. In contrast, "false" diverticula contain only mucosa and submucosa, while "intramural" diverticula are confined to the submucosa.

The classification of esophageal diverticula depends upon their location. They predominantly occur in three areas:

Immediately above the upper esophageal sphincter (Zenker's diverticulum)

Near the midpoint of the esophagus (traction diverticulum)

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Literature review current through: Nov 2017. | This topic last updated: Jul 05, 2017.
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