STM Article Repository

Zenker's diverticulum (hypopharyngeal pouch) is a rare medical entity caused by herniation of esophageal mucosa and submucosa through an anatomical defect between the layers of the inferior constrictor muscle. It is believed that this occurs mainly due to incoordination between the stages of swallowing and the timely opening of the cricopharyngeus muscle. It usually affects the elderly and patients usually present with dysphagia, regurgitation of food, halitosis and aspiration. The usual treatment has been an open surgical procedure; and in elderly patients, it just adds to their morbidity who already are having other concomitant chronic illnesses such as hypertension, diabetes mellitus and ischemic heart disease. So, procedures causing less morbidity have been sought to address this issue. We describe one case of Zenker's diverticulum in a 75-year-old Saudi female. There was no history of weight loss or recurrent chest infections. She was otherwise healthy with a history of well-controlled hypertension and osteoarthritis involving the joints of the lower limbs. We successfully managed her in the Ear Nose Throat (ENT) department, North West Armed Forces Hospital, Tabuk, Saudi Arabia by endoscopic staple-assisted diverticulotomy resulting in the successful division of the intervening septum between the diverticulum and the esophagus. This technique was well-tolerated by the patient with an early return to oral feeding and a shorter hospital stay. Zenker's diverticulum is an acquired pulsion-type of diverticulum that develops in the elderly, most likely due to the ageing process. Endoscopic staple-assisted diverticulotomy is a relatively safer technique for dealing with this problem as compared to the traditional open procedure causing more morbidity, and we advocate its use to reduce patient morbidity in selected cases. It is now a well-established fact that endoscopic staple-assisted diverticulotomy has low morbidity and mortality with acceptable favorable outcomes.