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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）』「2013/03/09 17:42:30」(JST)

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In anatomy, 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]

Epidemiology

Zenker's diverticulum mainly affects older adults.

Mechanisms and manifestations

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 (variously known as Killian's triangle, Laimer's triangle, and the Killian-Laimer triangle). The result is an outpouching of the posterior pharyngeal wall, just above the oesophagus, specifically just above the cricopharyngeal muscle.^[3]

While it may be asymptomatic, Zenker diverticulum often causes clinical manifestations such as dysphagia (difficulty swallowing), and sense of a lump in the neck; moreover, it may fill up with food, causing regurgitation (reappearance of ingested food in the mouth), cough (as some food may be regurgitated into the airways), halitosis (smelly breath, as stagnant food is digested by microrganisms), potential infection of the pharyngeal areas due to food stuck, and involuntary gurgling noises when swallowing. It rarely, if ever, causes any pain.

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

Diagnosis

A simple barium swallow will normally reveal the diverticulum. Endoscopy should not be performed due to the risk of perforating the diverticulum.

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. closing off the diverticulum via a stapler inserted through a tube in the mouth). This may be performed through a fibreoptic endoscope.^[6]

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

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 Zenker'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. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0023-852X&volume=113&issue=6&spage=957.
^ 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. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?doi=10.1097/01.mlg.0000233508.06499.41.

External links

Zenker's diverticulum at eMedicine

UpToDate Contents

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1. ツェンカー憩室 zenkers diverticulum
2. 口臭 bad breath

English Journal

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum.

Faiss S1, Falck S, Cordruwisch W, Oldhafer KJ, Baumbach R.
Scandinavian journal of gastroenterology.Scand J Gastroenterol.2015 Jul 3:1-4. [Epub ahead of print]
OBJECTIVE: Zenker´s diverticulum (ZD) is a rare cause of dysphagia. Various surgical and flexible endoscopic therapies are available with either higher morbidity or either higher recurrence rate. Therefore, improved treatment options are needed.MATERIAL AND METHODS: This case report involves an 8
PMID 26139133

Importance of malnutrition and associated diseases in the management of Zenker's diverticulum.

Boucher S1, Breheret R2, Laccourreye L2.
European annals of otorhinolaryngology, head and neck diseases.Eur Ann Otorhinolaryngol Head Neck Dis.2015 Jun;132(3):125-8. doi: 10.1016/j.anorl.2015.01.004. Epub 2015 Feb 10.
OBJECTIVES: To study the impact of malnutrition on a population treated for Zenker's diverticulum and to look for the causes of persistence or recurrence of dysphagia after endoscopic surgery.MATERIAL AND METHODS: This retrospective study included 30 patients with Zenker's diverticulum treated by en
PMID 25680881

Japanese Journal

憩室固定術を施行したZenker憩室の1例

田中寿明,的野吾,森直樹,西村光平,日野東洋,白水和雄,藤田博正
日本気管食道科学会会報 65(3), 260-264, 2014
Zenker憩室は下咽頭食道移行部に発生する圧出性の憩室である。欧米での報告例は多いが，本邦では比較的まれな疾患である。憩室固定術は欧米では憩室切除術と同様に広く行われているが，わが国では憩室切除術が主に施行されており，憩室固定術の報告例はない。今回，Zenker憩室に対し憩室固定術を行い良好な結果が得られた1例を経験したので文献的考察とともに報告する。症例は78歳の男性で，強度な嚥下障害を主訴に …
NAID 130004470476

甲状腺腫瘍との鑑別を要したKillian-Jamieson憩室の1例

新原正大,佐藤弘,眞栁修平,後藤裕信,寺島雅典,坪佐恭宏
日本消化器外科学会雑誌 46(8), 555-563, 2013
　症例は71歳の男性で，2011年8月に嚥下時違和感を主訴に前医を受診し，頸部超音波検査を施行したところ甲状腺腫瘤を認め，当院頭頸部外科に紹介となった．穿刺吸引細胞診にて食残を認めたため食道憩室が疑われ当科紹介となった．食道造影および頸部CT所見よりKillian-Jamieson憩室（以下，K-J憩室と略記）と診断した．手術を希望されたため，2012年5月に手術を施行した．手術は左頸部に切開をお …
NAID 130004908135

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
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