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a herniation through the muscular wall of a tubular organ (especially the colon)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/11 00:27:02」(JST)

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A Zenker's diverticulum, also pharyngoesophageal diverticulum, also pharyngeal pouch, also hypopharyngeal diverticulum, is a diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle (i.e. above the upper sphincter of the esophagus). It is a false diverticulum (not involving all layers of the esophageal wall).

It was named in 1877 by German pathologist Friedrich Albert von Zenker.^[1]^[2]

Signs and symptoms

In simple words, when there is excessive pressure within the lower pharynx, the weakest portion of the pharyngeal wall balloons out, forming a diverticulum which may reach several centimetres in diameter.

More precisely, while traction and pulsion mechanisms have long been deemed the main factors promoting development of a Zenker's diverticulum, current consensus considers occlusive mechanisms to be most important: uncoordinated swallowing, impaired relaxation and spasm of the cricopharyngeus muscle lead to an increase in pressure within the distal pharynx, so that its wall herniates through the point of least resistance (known as Killian's triangle, located superior to the cricopharyngeus muscle and inferior to the inferior constrictor muscles). The result is an outpouching of the posterior pharyngeal wall, just above the esophagus.^[3]

While it may be asymptomatic, Zenker diverticulum can present with the following symptoms:

Dysphagia (difficulty swallowing), and sense of a lump in the neck
Food might get trapped in the outpouching, leading to:
- Regurgitation, reappearance of ingested food in the mouth
- Cough, due to food regurgitated into the airways)
- Halitosis, smelly breath, as stagnant food is digested by microorganisms
- Infection

It rarely, if ever, causes any pain.

Cervical webs are seen associated in 50% of patients with this condition.

Rarer forms of cervical esophageal diverticula are the Killian's diverticulum and the Laimer's diverticulum. Killian's diverticulum is formed in the Killian-Jamiseon triangle (located inferior to the cricopharyngeus on both sides of this muscle's insertion into the cricoid cartilage). Laimer's diverticulum is formed in Laimer's triangle (located inferior to the cricopharyngeus in the posterior midline above the confluence of the longitudinal layer of esophageal muscle). Laimer's triangle is covered only by the circular layer of esophageal muscle.

Diagnosis

Lateral X-ray of a Zenker's diverticulum

AP X-ray of a Zenker's diverticulum

The simple barium swallow will normally reveal the diverticulum. An upper GI endoscopy also shows the diverticulum. Sipping contrast and taking a CT also gives a definite diagnosis.

Treatment

If small and asymptomatic, no treatment is necessary. Larger, symptomatic cases of Zenker's diverticulum have been traditionally treated by neck surgery to resect the diverticulum and incise the cricopharyngeus muscle. However, in recent times non-surgical endoscopic techniques have gained more importance (as they allow for much faster recovery), and the currently preferred treatment is endoscopic stapling^[4]^[5] (i.e. diverticulotomy with staples ). This may be performed through a diverticuloscope. Other methods include fibreoptic diverticular repair.^[6]

Other non-surgical treatment modalities also exist, such as endoscopic laser, which recent evidence suggests is less effective than stapling.^[7]

Epidemiology

Zenker's diverticulum mainly affects older adults. It has an incidence of 2 per 100,000 per year in the UK, but there is significant geographical variation around the world.^[8]

References

^ synd/2461 at Who Named It?
^ F. A. Zenker and Hugo Wilhelm von Ziemssen. Krankheiten des Oesophagus. Leipzig, 1867.
^ van Overbeek JJ (July 2003). "Pathogenesis and methods of treatment of Zenkr's diverticulum". Ann. Otol. Rhinol. Laryngol. 112 (7): 583–93. PMID 12903677.
^ Sen P, Bhattacharyya AK (August 2004). "Endoscopic stapling of pharyngeal pouch". J Laryngol Otol 118 (8): 601–6. doi:10.1258/0022215041917817. PMID 15453934.
^ Chang CY, Payyapilli RJ, Scher RL (June 2003). "Endoscopic staple diverticulostomy for Zenker's diverticulum: review of literature and experience in 159 consecutive cases". Laryngoscope 113 (6): 957–65. doi:10.1097/00005537-200306000-00009. PMID 12782805.
^ Altman JI, Genden EM, Moche J (May 2005). "Fiberoptic endoscopic-assisted diverticulotomy: a novel technique for the management of Zenker's diverticulum". Ann. Otol. Rhinol. Laryngol. 114 (5): 347–51. PMID 15966520.
^ Miller FR, Bartley J, Otto RA (September 2006). "The endoscopic management of Zenker diverticulum: CO2 laser versus endoscopic stapling". Laryngoscope 116 (9): 1608–11. doi:10.1097/01.mlg.0000233508.06499.41. PMID 16954989.
^ Siddiq, MA; Sood, S; Strachan, D (August 2001). "Pharyngeal pouch (Zenker's diverticulum).". Postgraduate medical journal 77 (910): 506–11. PMID 11470929.

External links

Zenker's diverticulum at eMedicine

UpToDate Contents

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1. ツェンカー憩室 zenkers diverticulum
2. 口腔咽頭嚥下障害の診断および治療 diagnosis and treatment of oropharyngeal dysphagia
3. 口腔咽頭嚥下障害の病因および臨床症状 pathogenesis and clinical manifestations of oropharyngeal dysphagia
4. 上部消化管内視鏡検査（食道胃十二指腸内視鏡検査）の概要 overview of upper gastrointestinal endoscopy esophagogastroduodenoscopy
5. 成人における嚥下障害の評価 evaluation of dysphagia in adults

English Journal

A systematic review of carcinoma arising in pharyngeal diverticula: A 112 year analysis.

Khan AS, Dwivedi RC, Sheikh Z, Khan SN, Dwivedi RC, Agrawal N, Kazi R, Rhys-Evans P.SourceHead and Neck Unit, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
Head & neck.Head Neck.2013 Aug 30. doi: 10.1002/hed.23491. [Epub ahead of print]
INTRODUCTION: Carcinoma is a rare complication of pharyngeal diverticula (PD). There is a paucity of information about its incidence, presentation, management and treatment outcomes. A systematic review and analysis of all reported cases has been carried out.METHODS & MATERIALS: A comprehensive
PMID 23996210

Alternative endoscopic treatment of Zenker's diverticulum: a case series (with video).

Manno M, Manta R, Caruso A, Bertani H, Mirante VG, Osja E, Bassotti G, Conigliaro R.SourceGastroenterology and Digestive Endoscopy Unit, New S. Agostino-Estense Civil Hospital, Modena, Italy.
Gastrointestinal endoscopy.Gastrointest Endosc.2013 Aug 26. pii: S0016-5107(13)02128-7. doi: 10.1016/j.gie.2013.07.012. [Epub ahead of print]
PMID 23987574

Zenker's diverticulum: exploring treatment options.

Bizzotto A, Iacopini F, Landi R, Costamagna G.SourceDigestive Endoscopy Unit, Catholic University, Rome, Italy;
Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale.Acta Otorhinolaryngol Ital.2013 Aug;33(4):219-229.
in

English, ItalianIl diverticolo di Zenker è una estroflessione sacciforme della mucosa e sottomucosa che si sviluppa a livello della parete posteriore della giunzione faringoesofagea attraverso il triangolo di Killian. Il diverticolo di Zenker è il più frequente tra i diverticoli del tratto

PMID 24043908

Japanese Journal

巨大 Zenker 憩室手術例

新川智佳子,小池修治,那須隆,野田大介,石田晃弘,青柳優
耳鼻咽喉科臨床 104(10), 733-739, 2011-10-01
… Zenker’s diverticulum results from increased intrapharyngeal pressure and is very rare in Japan. … We report a case of huge Zenker’s diverticulum treated by diverticulectomy. … A 73-year-old man seen for dysphagia and anterior neck swelling after eating was suspected of Zenker’s diverticulum from computed tomography (CT) and magnetic resonance imaging (MRI) findings. …
NAID 10029659259

Zenker 憩室の合併がてんかん発作のコントロールに影響した慢性血液透析患者の1例

原正樹,中村裕也,森戸卓,矢吹恭子,岡庭あすか,安藤稔
日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy 43(10), 859-863, 2010-10-28
… Zenker憩室が発見された．その後当院食道外科でZenker憩室の内視鏡的隔壁切開術が施行された．それ以降はフェノバルビタール錠180mgの内服のみで安定した血中濃度が得られるようになり痙攣発作も消失した．したがって，本症例では内服した抗痙攣薬の一部がZenker憩室内に捕捉されることで血中濃度が不安定になり痙攣発作が誘発されたと考えられた．Zenker …
NAID 10027724976

Related Pictures

★リンクテーブル★

リンク元	「ツェンカー憩室」「pharyngeal diverticulum」

「ツェンカー憩室」

Zenker's diverticulum
Classification and external resources
ICD-10	K22.5
ICD-9	530.6
DiseasesDB	31174
eMedicine	med/2777
Patient UK	Zenker's diverticulum
MeSH	D016672

　　[★]

英: Zenker's diverticulum、Zenker's diverticula、Zenker diverticulum、Zenker diverticula
同: ツェンケル憩室 Zenker憩室、咽頭食道憩室 pharyngoesophageal diverticulum、咽頭憩室
関: 憩室、仮性憩室、食道憩室

[show details]

ツェンカー憩室 : 約 557 件
ツェンケル憩室 : 59 件

図：RNT.199

まとめ

圧出性憩室、仮性憩室：上部食道括約筋である輪状喉頭筋の弛緩と咽頭の収縮の協調不全の結果、食道入口部の内圧が上昇し粘膜が脱出。

概念

咽頭食道移行部後壁の食道筋層の抵抗減弱部から圧出して生じた憩室(圧出性憩室)。筋層を欠く(仮性憩室)。(SSUR.449)
成因：上部食道括約筋である輪状咽頭筋の弛緩と喉頭の弛緩の強調不全の結果、食道入口部の内圧が上昇し粘膜が脱出する。(SSUR.449)
Killian三角とよばれる筋層が薄い部分から粘膜が圧出される。

症状

SSUR.449

Zenker憩室は入口の狭い嚢状の構造のため、飲食物が貯留しやすいうえ、咽頭や喉頭に近いため、他の憩室に比べて症状が出やすい。

咽頭部の違和感、咳、逆流など。

診断

食道X線写真造影検査：側面像で食道の背側に突出する嚢状構造。(SSUR.449)

治療