Esophageal diverticula

The diverticulum is the protrusion of the wall of the hollow organ ( diverticulum branch from the main path).

Distribution

 * 1) right (formed by all layers of the wall) x false (mucosa and submucosa glistening through the muscle)
 * 2) traction (arising from external tension) x pulse (arising from increased intraluminal pressure)
 * 3) according to localization: pharyngoesophageal x parabronchial x epiphrenic

Zenker's diverticulum (pharyngoesophageal)

 * pulse false diverticulum jutting between pars thyreopharyngea and cricopharyngea m. constrictor pharyngis inf.
 * occurs in cervical achalasia (increased tone of the upper esophageal sphincter)
 * clinical picture:
 * upper dysphagia with regurgitation
 * foetor ex ore
 * arching on the neck when swallowed
 * the possibility of aspiration of the contents with the subsequent development of bronchopneumonia

Parabronchial diverticulum

 * traction right diverticulum in the area of ​​bifurcation of the trachea is formed by pulling behind the esophageal wall by the scarring inflammatory process of the mediastinal nodes
 * it is usually not manifested clinically, until at large dimensions it can cause problems by pressure on the surroundings, event. bronchoesophageal fistula may occur

Epiphrenic diverticulum

 * false pulse diverticulum caused by achalasia (lower esophageal sphincter hypertension)
 * clinical picture: dysphagia

Diagnostics

 * X- ray passage of the contrast agent through the esophagus, barium suspension, in case of suspected perforation we will use iodine suspension
 * esophageal manometry (assessment of achalasia)
 * endoscopy

Treatment

 * surgical, if the diverticulum is a problem - for larger diverticula resection and suture of the wall (classic or stapler), smaller can be left or submerged
 * treatment of the cause - in achalasia myotomy is performed in Zenker's diverticulum with upper sphincter hypertension and in epiphenic with lower esophageal sphincter hypertension
 * administer ATB after surgery (possibility of mediastinitis due to putrefactive processes taking place in the stagnant content of diverticula)
 * complications of Zenker's diverticulum operation - recurrence of the laryngeal nerve.

Related Articles

 * Esophagus
 * Diseases of the esophagus

Zdroj

 * PASTOR, Jan. Langenbeck's medical web page  [online]. [feeling. 2009]. < https://langenbeck.webs.com/ >.
 * PASTOR, Jan. Langenbeck's medical web page  [online]. [feeling. 2009]. < https://langenbeck.webs.com/ >.


 * PASTOR, Jan. Langenbeck's medical web page  [online]. [feeling. 2009]. < https://langenbeck.webs.com/ >.