Zenker diverticulum is a very rare type of digestive tract pathology. Such a disease accounts for 3-5% of all cases. Externally, the pathology is manifested by a saccular protrusion of the mucous membrane of the esophagus and pharynx, may have a different shape and size. A digestive tract defect initially occurs on its posterior wall, after which it reaches the lateral ones. The pharyngeal-esophageal diverticulum is both a congenital and an acquired disease, the development mechanism of which is most often pulsional, as it occurs in the weakest point of the organ due to increased pressure in its lumen.
Features of the disease
Zenker diverticulum develops very slowly. Its dimensions can be different, reaching in some cases the size of the head of a newborn. A diverticulum has a neck and body covered with mucous epithelium. In its cavity there may be a liquid, the volume of which is capable of reaching 1.5 liters.
This formation is located behind the esophagus and to the left of it, towards the upper mediastinum. Very rarely, an intramural form of pathology develops when a diverticulum penetrates into the space between the muscles of the walls of the esophagus.
Reaching large sizes, this formation begins to exert pressure on organs located nearby. Such diverticulums do not grow together and do not cause inflammation in the surrounding tissues until peridiverticulitis develops.
The main causes of the disease
With the normal process of swallowing food, a contraction of the muscles of the pharynx occurs, the fibers of the cricopharyngeal muscle begin to relax, and the mouth of the esophagus opens. If muscle activity is disturbed, a diverticulum occurs.
The main causes of the formation of pathology are:
- hereditary predisposition;
- esophageal mucosal injury;
- congenital muscle tissue diseases;
- sclerosis and cartilage calcification;
- violation of intrauterine development;
- muscle tissue defects;
- spinal injuries;
- inflammatory diseases of the esophagus and pharynx.
Clinical manifestations of pathology
How is such a diverticulum manifested? It depends on its size. Small defects (up to 2 cm) do not manifest themselves in any way and are accidentally detected by x-ray or fluoroscopic examination.
If Zenker diverticulum occurs, the symptoms of this disease are divided according to the stages of the disease.
Features of the first stage
The first stage is characterized by nonspecific manifestations. These include: sore throat, excessive salivation or, conversely, dryness of the oral mucosa. Unpleasant odors (rot, rotten rot, hydrogen sulfide) follow the patient. A rare cough or difficulty swallowing may occur . During eating, there is an increase in tone, accompanied by tension in the muscles of the neck, as a result of which the patient feels as if a lump allegedly rolls up to his throat. After some time, the patient develops a lifestyle in which he does not notice a constant cough and belching and gets used to gargle after eating.
Features of the second and third stages
How is diverticulum manifested in the second stage? This period is characterized by stagnation of mucus, food, accumulation of air, but overall health does not worsen. On examination, the doctor reveals the asymmetry of the neck due to unilateral protrusion. It is soft to the touch, disappears upon palpation, and again increases in size during meals. When tapping the center of the thickening after drinking the liquid, a splash symptom occurs, and with lateral pressure rumbling is noted.
In the third stage, decompensation of the disease is noted. The manifestation of symptoms becomes more pronounced, overall well-being worsens significantly, the patient begins to lose weight dramatically.
The chronic inflammatory process occurring in the cavity of the diverticulum leads to various complications: pneumonia, asphyxia, abscesses, stagnation of venous blood, perforation of the walls of the esophagus, mediastinitis and the occurrence of malignant neoplasms.
Diagnostics
The main method for diagnosing Zenker diverticulum is radiological, carried out in different planes. Special preparations stain the cavity of the formation, which makes it possible to determine not only the exact location, but also its size, shape, length of the neck, excesses along its length, condition of adjacent organs and anatomical structures. If barium suspension begins to linger in the diverticulum cavity, this indicates the development of diverticulitis.
Conservative treatment of the disease
If Zenker diverticulum is diagnosed, treatment is carried out both conservatively and surgically. But if in the first case the pathology is not eliminated, only the operation can help. Conservative therapy is resorted to only if there are serious contraindications to surgery. In this case, the patient must adhere to a strict diet, a soft diet, and thoroughly chewing food. After eating, the patient is drained by a diverticulum, for this he must lie in a certain position. In addition, this formation is washed, and the patient must also take vegetable or paraffin oil to lubricate its walls.
Surgery
Most often it helps with a disease such as Zenker diverticulum, an operation that is indicated during the second and third stages of the development of the disease, accompanied by complications. 48 hours before surgery, the patient is prescribed a liquid diet and the formation is thoroughly washed through an esophagoscope or catheter.
With Zenker diverticulum, the type of operation will be a simultaneous diverticulectomy, which consists in removing the tissue of the bag of this formation through an incision. Before surgery, the patient is injected with a thick probe into the esophagus, thereby facilitating the operation. The diverticulum isolated from the surrounding tissues is crossed at the base and sutured with a knotted or continuous seam. A pathological formation is removed using a stapler, which is applied to its base.
Then, an extramucosal esophagomyotomy several centimeters long is performed on the inserted probe. If the diverticula are small, only one cricofaringeal myotomy is enough, after which they straighten and together with the mucous membrane of the digestive tract make up a flat wall.
Recently, some clinics began to conduct surgery endoscopically , i.e., without making an incision on the neck. Its essence is that they cut the common wall between the diverticulum and the esophagus and, using an endoscopic stapler, carry out myotomy. After such an operation, the patient recovers much faster, and the number of complications is also reduced.
Postoperative period after removal of Zenker diverticulum
Features of this period are that the patient should not eat food for 48 hours. Some surgeons leave a probe for 3-4 days to feed the patient liquid food. After extracting it, on the 5-6th day they give already semi-liquid food, gradually expanding the diet.
If this disease is not treated, the prognosis is extremely unfavorable. Various complications lead to death in 23-33% of cases.
Output
Thus, the Zencker diverticulum is a very insidious disease. Without manifesting itself at the very beginning of its development, after a while it significantly worsens the state of health. It should be treated necessarily, because there is a high probability of death from various complications.