What Is Zenker's Diverticulum?

In 1769, the British surgeon Ludlow first reported the pharyngeal esophageal diverticulum, but because the German pathologist Zenker made the correct analysis and observation of the pharyngeal esophageal diverticulum in 1874, it was named Zenker diverticulum. Pharyngopharyngeal diverticulum accounts for about 60% of esophageal diverticulum, and it is more common in patients aged 50 to 80 years. It is very rare for patients under 30 years old to have an incidence of 0.1% during routine upper gastrointestinal barium imaging.

Pharyngeal esophageal diverticulum

Pharyngopharyngeal diverticulum is the most common esophageal diverticulum located near the back of the cyclopharyngeal muscle (Figure 2), or the posterior wall of the pharyngeal-esophageal junction above the circumpharyngeal muscle.

Pharyngopharyngeal diverticulum

Classification and etiology of pharyngopharyngeal diverticulum

Definition of pharyngoesophageal diverticulum

Definition: The pharyngeal esophagus wall is limited and protrudes outward, forming a blind bag with complete epithelium that communicates with the esophagus cavity. Most of them are acquired, and congenital diverticulum is rare.

Pharyngopharyngeal diverticulum type

Classification: According to the occurrence site and mechanism, it is divided into three categories:

(1)

Pharyngopharyngeal diverticulum: Occurs at the junction of pharyngeal esophagus, also known as Zenker's diverticulum, and its occurrence is related to dysphagia of esophageal muscles, increased pressure in the esophageal cavity caused by dysfunction of cyclopharyngeal muscles, and weakness in the local muscle anatomy.

(2)

Middle esophageal diverticulum: Mostly located in the middle esophagus at the level of the tracheal delimitation, often caused by chronic inflammatory adhesions of the mediastinal esophagus and shrinkage of scar tissue, mostly caused by hilar or mediastinal lymph tuberculosis inflammation.

(3)

Upper diaphragmatic diverticulum: Occurred on the right side of the esophagus 5-10cm above the diaphragm. Its formation may be related to functional or mechanical obstruction of the lower part of the esophagus, which increases the pressure in the esophagus, and causes the esophageal mucosa to protrude through the weak area of the esophageal muscle layer.

Pseudo diverticulum & mdashmdash; pharyngeal esophageal diverticulum and supracondylar diverticulum. The protruding blind bag is only the esophageal mucosa and not the whole layer of the esophagus. It is also called bulging diverticulum.

True diverticulum & mdashmdash; mid-esophageal diverticulum. Its protruding blind bag contains the entire layer of the esophagus wall.

Clinical symptoms: It is related to the diverticulum site, the size of the inner mouth, the presence or absence of food or inflammation, and complications. If the contents return, there may be respiratory symptoms.

(1) Pharyngopharyngeal diverticulum: Slow and progressive dysphagia. Sounds can be heard when squeezing the neck or swallowing. The regurgitant is often just swallowed food without bitterness.

(2) Diverticula in the middle of the esophagus: due to the large internal mouth, which is conducive to drainage, and little food retention, it is not easy to produce symptoms, occasionally difficulty swallowing or swallowing, and occasional local abscesses or fistulas may appear corresponding symptoms.

(3) Upper diaphragmatic diverticulum: Symptoms are mild, occasionally indigestion or difficulty swallowing.

Diagnosis: Esophageal angiography, esophagoscopy, and esophageal function tests.

Treatment: Small asymptomatic diverticulum can be treated without surgery. Symptoms are feasible with conservative medical treatment. Large diverticula with obvious symptoms should be treated surgically.

Surgical methods: Methods include suturing the diverticulum or partial excision of the esophageal diverticulum, and associated tachycardia and snoring should be treated accordingly. The surgical approach is selected according to the location of different types of diverticulum. Neck esophageal diverticulum can be removed by small incision of the neck.

How esophageal diverticulum occurs

Pharyngopharyngeal diverticulum is more common in adults over 50 years of age than men.

A very small number of esophageal diverticulum cancers may be caused by long-term stimulation of food and secretions. Patients habitually pressurize diverticula to facilitate diverticulum emptying, and may also be a cause of canceration. If irregularities are found in the diverticulum wall when taking barium angiography, the canceration of diverticulum should be highly suspected and further examination is needed.

The superior diverticulum is also a bulging diverticulum. The wall of the diverticulum has only a mucosal layer and a submucosal layer, and few muscle fibers. Most literature reports that most of the supracondylar diverticulum is accompanied by esophageal motor dysfunction, hiatal hernia and esophageal reflux. Esophageal reflux often causes spasm of esophageal muscles, which increases the pressure in the esophagus and causes bulging diverticulum.

The middle esophageal diverticulum can be bulging or retractable. Most of the esophageal diverticulum is similar to the etiology and performance of the supracondylar diverticulum, and the diverticulum is due to inflammation of the bronchial lymph nodes or tuberculosis. Caused by scar traction, it has full-thickness tissue of the esophagus, including the mucosa, submucosa, and muscle layer. The neck is wide and the bottom is narrow like a tent. Pull-out diverticulum mostly occurs in the anterior esophageal wall and the right wall of the bifurcation of the trachea. Some authors believe that part of the middle esophageal diverticulum unrelated to esophageal movement abnormalities is congenital intestinal cysts or esophageal duplication.

Pseudoesophageal diverticulum is rare and the cause is unknown.

The pathological change was due to the dilation of the submucosal gland ducts, and the lesions were confined to the submucosa and did not affect the esophageal muscle layer. The dilated duct is cystic, with chronic inflammation around it, and may form small abscesses. The inflammatory changes of the glandular tube and the squamous epithelial metaplasia can narrow or completely block the lumen, causing the proximal dilatation to form a pseudo diverticulum. Due to chronic inflammation, fibrosis of the submucosa of the esophagus causes the wall of the esophagus to thicken, stiff, and narrow the lumen. Pseudo diverticulum can affect the full length of the esophagus, but it is more common in the upper part of the esophagus, which is consistent with the distribution of the submucosal glands in the esophagus. Many patients with pseudo diverticulum also have junk diabetes.

- Pharyngopharyngeal diverticulum-Clinical manifestations

Pharyngeal esophageal diverticulum

Pharyngopharyngeal diverticulum symptoms and signs

Patients with pharyngeal esophageal diverticulum may have no clinical symptoms, but the vast majority of patients have symptomatic diverticulum in the early stage of onset. Once the diverticulum is formed, its volume increases progressively, and the patient's symptoms gradually worsen, and the frequency or frequency of symptom onset is increasing. Complications occur.

The typical clinical symptoms of patients with pharyngoesophageal diverticulum include difficulty swallowing the high neck esophagus, smell of rancid stench during breathing, and a "click" in the pharynx when swallowing food or drinking water. Whether coughing or not, patients often have spontaneous esophagus Content reflux phenomenon. Typical reflux products are fresh, undigested foods that have no bitter or sour taste or contain gastroduodenal secretions. Individual patients experience esophageal reflux immediately after eating

Gastroduodenum For example, this reflux is related to the severe cough and belching caused by diverticulum contents being mistakenly sucked into the airways. Due to esophageal reflux and coughing, patients eat slowly and laboriously.

As the volume of the esophagus and esophagus continues to increase, the patient's throat often feels bloated. This feeling can be relieved or alleviated by pressing the affected neck with his hand. Occasionally, patients come to the clinic due to the stench caused by the decomposition of the diverticulum contents. Very few patients complain of a soft mass in their neck.

Pharyngopharyngeal diverticulum clinical staging

Some authors divide the clinical symptoms of esophageal diverticulum into three stages.

Stage : The diverticulum is small, and the patient's opening is at right angles to the longitudinal axis of the esophagus. Patients without cervical esophageal obstruction, no esophageal reflux, or diverticulum contents are retained. The main symptom of the patient is a foreign body sensation in the throat and an attempt to exclude the "foreign body" by coughing or sputum. The predisposing factor is often to eat a piece of dry food (such as toast, etc.), and the foreign body sensation in the throat disappears after it is spit out.

Stage II: After the pharyngeal esophageal diverticulum is enlarged to a certain extent, the opening of the diverticulum and the diverticulum body are oblique. The main symptom is that the patient's mouth suddenly discharges the original diet and is mixed with mucus and saliva. This symptom can occur during sleep and can lead to aspiration. Patients who wake up from sleep due to paroxysmal cough can cause pulmonary abscess and should be taken seriously. Some patients make gurgling noise or ticking when swallowing, which is the sound produced when the gas and liquid in the diverticulum capsule are mixed.

Stage : After the diverticulum sac enlarges to a certain size, the diverticulum mouth is in a horizontal or horizontal position. The swallowed diet can directly enter the diverticulum, and the patient may develop other symptoms, such as different degrees of high neck esophageal obstruction, with some or The esophagus refluxed all the food. Such patients often have weight loss and emaciation.

- Pharyngopharyngeal diverticulum-Diagnosis

Development and evolution of esophageal diverticulum

The clinical diagnosis of pharyngeal esophageal diverticulum mainly depends on the medical history, physical examination and esophageal X-ray barium meal examination, the latter of which plays a key role in the diagnosis.

1. Examination of patients with pharyngeal esophageal diverticulum may have the following signs during examination:

(1) The patient is instructed to drink water, and auscultation can be heard on the neck diverticulum when swallowing.

(2) McNealy-McCallister test: This simple clinical test is used to determine the position (side) of the pharyngoesophageal diverticulum in the neck.

Sternocleidomastoid muscle Methods: The patient takes a seated position and faces the examiner; After instructing the patient to swallow air a few times, the examiner places his left thumb on the patient's right neck, the sternocleidomastoid muscle, and the cartilage. Squeeze; The examiner repeatedly squeezes the corresponding part of the patient's right neck with his right thumb; When the examiner's thumb is squeezed on the neck on the side of the pharyngoesophageal diverticulum, due to the squeeze of the thumb, the diverticulum The inner trachea is discharged through the liquid, so the examiner can hear the sound of air passing through the neck of the affected side of the patient.

2. Auxiliary examination of barium meal of esophagus shows that there is a round, oval or pear-shaped esophageal diverticulum at the edge of the affected esophagus. The barium, air and liquid swallowed into the diverticulum sac have three layers; esophagoscopy shows that there is a foreign body in the diverticulum. Individual patients have esophagitis, esophageal stricture, webbed esophagus, or esophageal cancer.

- Pharyngopharyngeal diverticulum-Examination

Pharyngopharyngeal diverticulum

The condition of esophageal diverticulum is mostly progressive, and non-surgical conservative treatments are ineffective. Therefore, after the diagnosis is clear, elective surgery should be performed as soon as possible before complications occur.

Preoperative preparation of esophageal diverticulum

Generally, no special preoperative preparation is needed. Very few patients need intravenous fluid replacement to correct malnutrition. Comorbidities must be actively treated. After the condition is controlled, surgery can be performed. It does not take long to wait. The cause of the comorbidity is completely eliminated by surgery. cure.

Take liquid food within 48 hours before surgery, and change the position as much as possible to remove the residues in the diverticulum. If you can send the nasogastric tube to the diverticulum under perspective, and repeatedly rinse and absorb the residue, it will help prevent mistakes during induction of anesthesia. Suck. The gastric tube retained in the diverticulum is helpful to find and dissect the diverticulum during the operation and facilitate the operation.

Pharyngoesophageal diverticulum anesthesia

Endotracheal intubation under general anesthesia can control breathing and prevent aspiration, which is convenient for surgical operation.

Pharyngopharyngeal diverticulum surgery method

The esophageal diverticulum is mostly located to the left behind the midline. The left neck approach is often used for surgery, but it must be determined based on the preoperative angiography. If the diverticulum is biased to the right, the right neck approach should be used.

Supine position, head turned to the healthy side, take an incision of the sternocleidomastoid muscle from the hyoid bone level to 1cm above the collarbone, cut off the platysma, and separate the sternocleidomastoid muscle and surrounding tissues and muscles before the trachea and Pull to the side to expose the scapula hyoid muscle. Resection or distraction is more conducive to the display of diverticulum. Retract to the side, the removal is more conducive to the exposure of the diverticulum. Pull the carotid artery laterally, cut off the inferior thyroid artery and middle thyroid vein, draw the thyroid to the midline, pay attention to protect the recurrent laryngeal nerve in the tracheoesophageal sulcus, and carefully identify the diverticulum wall. You can touch the gastric tube in the diverticulum with your hand. Ask the anesthesiologist to slowly inflate the diverticulum through the gastric tube to make the diverticulum bulge for easy identification. Lift the diverticulum sac with ratchet forceps and dissect the neck of the diverticulum along the sac wall. The lower edge of the diverticulum neck is the upper edge of the circumpharyngeal muscle, and the upper edge is the lower edge of the pharyngeal muscle. The transverse fibers of the circumpharyngeal muscle and the esophageal muscle layer are cut from the top to the bottom along the midline and about 3 cm. Separate left and right up to half the circumference of the esophagus to swell the mucosa without further treatment. If the diverticulum is large, it should be removed, and the gastric tube originally in the diverticulum should be sent into the esophageal cavity. Use the vascular forceps to clamp the neck of the diverticulum equal to the longitudinal axis of the esophagus, remove the diverticulum wall, and close the esophageal mucosa. Intracavity, pay attention not to remove too much, so as not to cause esophageal stricture. A drainage bar was placed for drainage, and the neck incision was sutured layer by layer.

Postoperative Pharyngopharyngeal Diverticulum

Food can be taken orally on the second day after treatment, and drainage strips are removed when there is not much drainage 48 to 72 hours after surgery.

Surgical comorbidities are mainly recurrent laryngeal nerve injuries, and most can recover on their own. Followed by the repair of leakage or fistula formation, local dressing change, and more can heal. If esophageal stenosis occurs, esophageal dilatation is feasible.

Pharyngopharyngeal diverticulum structure diagram

1. Esophageal barium meal contrast The clinical diagnosis of pharyngeal esophageal diverticulum depends on esophageal barium meal contrast. After swallowing the barium, the patient can determine the position and size of the diverticulum, the thickness and emptying of the diverticulum neck, and the relationship between the fasting and the esophageal axis through fluoroscopy and radiographs (positive and lateral photographs of the esophagus are required).

During esophageal barium meal imaging, once the swallowed barium is filled or enters the diverticulum, it can be seen that the pharyngeal esophageal diverticulum containing barium is located at the lower edge of the affected esophagus. The affected esophagus above the diverticulum sometimes becomes thinner or the lumen contracts, which is easily mistaken for barium-filled diverticulum compression. However, regardless of the perspective, the stenosis of the affected esophagus is uniform and narrow, which is completely different from the stenosis caused by local esophageal compression. Observed from the side view of esophagus barium meal radiography, the obvious notch at the posterior edge of the esophagus at the level of the cyclopharyngeal muscle is caused by the compression of the local esophagus by the pharyngeal esophageal diverticulum.

2. The clinical diagnosis of esophageal diverticulum by esophagoscopy usually does not require esophagoscopy. However, if a diverticulum is suspected of having a tumor, if the patient has other organic lesions that cause symptoms, or if there is a foreign body in the diverticulum, an esophagoscopy (gastroscopy) should be performed. However, extra care must be taken during the examination to avoid inserting the endoscopic lens into the diverticulum capsule and causing instrumental perforation of the diverticulum. Individual patients with pharyngeal esophageal diverticulum can find esophagitis, esophageal stricture, Webbed or esophageal cancer.

- Pharyoesophageal diverticulum-Recovery and nursing

Multiple parts of pharyngeal esophageal diverticulum

Pharyngopharyngeal diverticulum refers to a blind bag connected to the esophagus cavity and covered with epithelium. There are 3 good hair spots:

Pharyngo-esophageal diverticulum; Occurring at the junction of pharyngeal and esophagus, it is a bulging diverticulum;

Parabronchial diverticulum; it occurs in the middle of the esophagus, also known as the middle esophageal diverticulum, which is a retractable diverticulum;

supracondylar diverticulum; it occurs in the upper part of the lower part of the esophagus and is also a dilated diverticulum. Pharyngopharyngeal diverticulum is more, followed by supracondylar diverticulum, parabronchial diverticulum is the least common. Whether the esophageal diverticulum produces symptoms last night is related to the size of the diverticulum, the location of the opening, and the presence of food and secretions. Most symptoms are mild and atypical.

Basopharyngeal diverticulum anatomy basis

The anatomical basis of the pharyngeal esophagus is that a defect in the rear center between the oblique fibers of the hypopharynx and the transverse fibers of the cyclopharyngeal muscle is more obvious to the left, so diverticulum occurs mostly on the left.

Pharyngeal esophageal diverticulum is often not caused by a single factor. Most of the diverticulum is formed due to dyskinesia, dyskinesia, or other movement abnormalities of the cyclopharyngeal and esophageal muscles.

Pharyngopharyngeal diverticulum is more common in adults over 50 years of age than men.

The middle esophageal diverticulum can be bulging or retractable. Most of the esophageal diverticulum is similar to the etiology and performance of the supracondylar diverticulum, and the diverticulum is due to inflammation of the bronchial lymph nodes or tuberculosis Caused by scar traction, it has full-thickness tissue of the esophagus, including the mucosa, submucosa, and muscle layer. The neck is wide and the bottom is narrow like a tent. Pull-out diverticulum mostly occurs in the anterior esophageal wall and the right wall of the bifurcation of the trachea. Some authors believe that part of the middle esophageal diverticulum unrelated to esophageal movement abnormalities is congenital intestinal cysts or esophageal duplication.

Pseudoesophageal diverticulum is rare and the cause is unknown.

Clinical manifestations of pharyngeal esophageal diverticulum

In the early days, there was only a small part of the diverticulum with prominent mucosa, which had a large opening and communicated with the pharyngeal esophagus at right angles. Food was not easy to remain, and there could be no symptoms or mild symptoms. Only occasionally when food stuck to the wall of the diverticulum was itchy throat. Symptoms are irritated and disappear when coughing or drinking food residues fall off.

If the diverticulum gradually increases, the accumulated food and secretions begin to increase, sometimes automatically returning to the mouth, occasionally causing aspiration. During this period, the patient could hear a sound in the pharynx due to air and food entering and leaving the diverticulum.

Due to the accumulation of food, the diverticulum will continue to grow and gradually fall, which is not conducive to the discharge of the accumulation in the diverticulum, causing the opening of the diverticulum to be directly below the pharynx. All the swallowed food first enters the diverticulum and returns, and swallowing occurs at this time. Difficulty and progressive worsening, some patients also have symptoms such as bad breath, nausea, and loss of appetite. Some suffer from malnutrition and weight loss due to eating difficulties.

If aspiration occurs, there will be complications such as pneumonia, atelectasis or lung abscess. Bleeding and perforation complications are rare.

Clinical manifestations of superior diverticulum: Most patients with superior diverticulum may have no symptoms or mild symptoms. Diverticula with traps and motor dysfunction may have different symptoms, such as mild indigestion, post-sternal pain, upper abdominal discomfort and Pain, bad breath, nausea, and cooing in the chest, etc., the huge sacral diverticulum pressing the esophagus can cause difficulty in swallowing and reflux causing aspiration.

Clinical manifestations of middle esophageal diverticulum:

Most retractable diverticula are small and have a wide neck and a narrow base, which are good for drainage and are not prone to food residues. Therefore, they are generally asymptomatic, often found in health checkups, or in between, and have not changed for many years. Dysphagia and pain occur only when the esophagus is stretched or deformed, and inflammation occurs in the diverticulum. If diverticulitis inflammation, ulcers, and necrotic perforations can cause complications such as bleeding, mediastinal abscesses, bronchial fistulas, and corresponding symptoms and signs.

Clinical manifestations of pseudoesophageal diverticulum: Patients often complain of mild dysphagia, symptoms appear intermittently or progress slowly. Esophageal pseudo diverticulum is more common in patients in the 50- and 60-year-old age group, with more men than women.

Diagnosis and diagnostic criteria of esophageal diverticulum:

There are not many positive physical signs in clinical physical examination. After swallowing a few mouthfuls of air, some patients repeatedly compress the anterior edge of the sternocleidomastoid muscle at the level of the cyclopharyngeal muscle, and can hear a sound.

The main method of diagnosis is X-ray examination. On the plain film, the liquid level is occasionally seen, and barium can be seen in the diverticulum behind the esophagus. If the diverticulum is huge and obviously oppresses the esophagus, it can be seen that after barium enters the diverticulum, a barium agent flows from the diverticulum opening to the lower esophagus. Repeated changes in body position during angiography are conducive to filling and emptying of the diverticulum, easy to find the small diverticulum and observe whether the mucosa in the diverticulum is smooth, except for early malignant changes.

Endoscopy is dangerous and should not be used as a routine test. It should only be performed when suspected malignancy or other deformities such as esophageal webbing or esophageal stenosis. Before the endoscope examination, instruct the patient to swallow a black silk thread as the guide wire of the endoscope, which can increase the safety of the inspection. The absence of the silk thread or the cluster of silk threads during the inspection indicates that the mirror end has entered. Diverticulum.

Diagnosis and diagnostic criteria of esophageal diverticulum and superior diverticulum

The supracondylar diverticula is often diagnosed by chest X-rays. A chest chest radiograph sometimes shows a diverticulum cavity containing a liquid plane. Barium radiography shows a diverticulum a few centimeters above the diaphragm, often protruding to the right, or to the left or front. Diverticula are extremely rare in the esophagus in the lower iliac abdomen. Diverticula can be combined with hiatal hernia at the same time, and multi-dimensional observation is needed during angiography to avoid missed diagnosis or misdiagnosis.

Endoscopy is dangerous and should only be performed when suspected malignancy and combined deformities are suspected.

The middle esophageal diverticulum also relies on X-rays to confirm the diagnosis. When taking barium angiography, you must use the lying position or the head and feet high position, and turn the body to the left and right to clearly show the outline of the diverticulum, because the openings in the middle esophageal diverticulum are relatively large, and the contrast agent is very large. It is easy to flow out of the diverticulum and not easy to stay in memory.

Endoscopy does not help much in the shallow middle esophagus diverticulum, and is performed only when malignant diverticulosis is suspected.

Diagnosis and diagnostic criteria of pseudoesophageal diverticulum: pseudo diverticula cannot be found during X-ray examination. Barium radiography can find multiple long-necked flask-shaped or small button-shaped pouches in the esophageal cavity. The size is 1 to 5 mm. Etc. It was scattered or localized, and the esophagus was significantly narrowed, and there were more pseudo diverticula. Therefore, it was thought that esophageal stenosis was related to inflammation around the pseudo diverticula.

Endoscopy showed chronic inflammatory changes in the esophagus. Only a few patients saw false diverticulum openings, and biopsy was not easy to confirm.

Many patients with pseudo diverticulum often have candida infections, which may be secondary, especially those with diabetes.

1. Preoperative preparation generally does not require special preoperative preparation. Very few patients need intravenous fluid replacement to correct malnutrition. Complications must be actively treated. After the condition is controlled, surgery can be performed. It does not take long to wait. The operation eliminates the cause of complication. In order to completely cure the comorbidities.

2. General anesthesia with endotracheal intubation can control breathing to prevent aspiration and facilitate surgical operation.

3. Surgical methods The pharyngeal esophageal diverticulum is mostly located to the left behind the midline. The left neck approach is often used for surgery, but it must be determined according to the preoperative angiography. If the diverticulum is biased to the right, the right neck approach should be used.

The lower part of the diverticulum neck is the upper edge of the circumpharyngeal muscle, and the upper part is the lower edge of the pharyngeal muscle. The transverse fibers of the circumpharyngeal muscle and the esophageal muscle layer are cut from the top to the bottom along the midline, and the esophageal mucosa and muscle layer of the diverticulum neck Separate left and right up to half the circumference of the esophagus to swell the mucosa without further treatment.

If the diverticulum is large, it should be removed, and the gastric tube originally in the diverticulum should be sent into the esophageal cavity. Use the vascular forceps to clamp the neck of the diverticulum equal to the longitudinal axis of the esophagus, remove the diverticulum wall, and close the esophageal mucosa. Intracavity, pay attention not to remove too much, so as not to cause esophageal stricture. A drainage bar was placed for drainage, and the neck incision was sutured layer by layer.

4. Postoperative treatment The second day after the operation can be taken orally. After 48 to 72 hours after operation, the drainage strip is removed.

Treatment of esophageal diverticulum and supracondylar diverticulum

: Symptomatic diverticulum or diverticulum gradually increasing during follow-up and signs of retention, or diverticulum combined with other deformities such as esophageal hiatal hernia, achalasia, etc. should be treated surgically. Special care should be taken to correct the combined deformity at the same time, otherwise complications or relapses are easy to occur.

1. The preoperative preparation is basically the same as that of the pharyngeal esophageal diverticulum, but the gastrointestinal preparation should be performed before the operation: metronidazole 0.4g orally 3 times a day for 3 days. 1 g of streptomycin was administered orally and enema after gastric lavage the night before the operation. These measures are beneficial to prevent the occurrence of esophageal fistula.

2. Anesthesia and esophageal diverticulum surgery, general anesthesia with endotracheal intubation.

3. Surgical approach The upper diverticulum is usually placed on the 7th costal bed on the left side. Although the diverticulum is sometimes located on the right side, the left chest approach is also convenient for surgery. After opening the chest, pull the lungs forward, cut the mediastinal pleura to reveal the esophagus, and pay attention to retaining the vagus nerve plexus. Touching the gastric tube in the diverticulum or asking the anesthesiologist to infuse the gastric tube to help identify the diverticulum. If the diverticulum is located on the right side of the esophagus, the esophagus can be freed and rotated to reveal the diverticulum. Diverticula are often hernias from a gap in the muscular layer of the esophagus.

After the interface between the esophageal circular muscle and the esophageal mucosa is identified, the muscular layer is incised to the distal end of the esophagus by about 3 cm and the proximal end by about 2 cm, and the diverticulum neck can be fully exposed. If the diverticulum is huge, the diverticulum can be excised and divided into two layers: the mucosal layer and the muscular layer. The proximal end reaches the level of the lower pulmonary veins and the distal end reaches 1 cm of the gastric wall. The incision of the cardia muscle layer should be on the side of the diverticulum neck suture repair to reduce the occurrence of fistula.

Routine closed chest drainage.

4. Postoperative treatment After the routine fasting, gastrointestinal decompression and intravenous fluid replacement, gastrointestinal decompression was stopped after the bowel sounds were restored, and the following day was taken orally. After the lungs are inflated and there is no pleural drainage, the thoracic drainage tube is removed.

Treatment of middle esophageal diverticulum: Asymptomatic retractable esophageal diverticulum does not require village treatment, and the symptoms can be observed for many years. Only when the symptoms gradually increase, the diverticulum gradually increases or complications such as inflammation, foreign body perforation, bleeding, etc. Only need surgery.

The cause of the retractable diverticulum should be removed during the operation, and the esophageal dyskinesia or obstruction that may be present, such as achalasia, diaphragmatic hernia, hiatal hernia, etc., should be corrected together to avoid recurrence or complications.

Preoperative preparation and anesthesia were performed with the supracondylar diverticulum.

The right thoracic approach is usually used. The mediastinal pleura is cut behind the hilum to confirm the esophagus. There are often enlarged lymph nodes and tightly adherent fibrous tissue around the diverticulum. It is difficult to free the diverticulum. Carefully and patiently remove the enlarged lymph nodes. When opening the diverticulum, be careful not to damage the esophagus, and divide the mucosa and muscle into two layers. Those with abscesses and fistulas must be removed and repaired together. The pleura, intercostal muscles, and pericardium can be used as solid tissues.

Treatment of Pseudoesophageal Diverticulum: The purpose of treatment is to reduce symptoms and manage the associated lesions. Generally no surgery is required. Esophageal dilation can reduce swallowing difficulties, and antacid treatment can reduce symptoms of esophageal inflammation. However, the X-ray performance of the pseudo diverticula remained unchanged and occasionally disappeared on its own.

Related Papers on Pharyngopharyngeal Diverticulum

Overview of pharyngopharyngeal diverticulum surgery

Keywords: Comorbid esophageal sternocleidomastoid muscle, thyroid, intragastric tube, esophageal hiatal hernia, esophageal diverticulum, general anesthesia, conservative therapy

Abstract: The condition of the pharyngeal diverticulum is mostly progressive, and non-surgical conservative treatments are ineffective. Therefore, after the diagnosis is clear, elective surgery should be performed as soon as possible before comorbidities occur. 1. Preoperative preparation generally does not require special preoperative preparation. Very few patients need intravenous fluid replacement to correct malnutrition. Complications must be actively treated. After the condition is controlled, surgery can be performed. It does not take long to wait. The operation eliminates the cause of complication. In order to completely cure the comorbidities. Eat liquid food within 48h before surgery, and change the position as much as possible to drain the residue in the diverter room.

Hospital information guidance services common: Overview of pharyngeal surgery treatment

The condition of the pharyngeal diverticulum is mostly progressive, and non-surgical conservative treatments are ineffective. Therefore, after the diagnosis is confirmed, elective surgery should be performed as soon as possible before comorbidities occur.

2. General anesthesia with endotracheal intubation can control breathing to prevent aspiration and facilitate surgical operation.

4. Postoperative treatment The second day after the operation can be taken orally. After 48 to 72 hours after operation, the drainage strip is removed.

Treatment of supracondylar diverticulum: Symptomatic diverticulum or diverticulum gradually increasing during follow-up and signs of retention, or diverticulum combined with other deformities such as hiatal hernia, achalasia, etc. should be treated surgically. Special care should be taken to correct the combined deformity at the same time, otherwise complications or relapses are easy to occur.

Ultrasound diagnosis of pharyngeal esophageal diverticulum

Author: Guxiu Fen

Author unit: Zhoushan Maternal and Child Health Hospital, Zhoushan, Zhejiang 316000

Journal name: ISTIC

What Is Zenker's Diverticulum?

Pharyngeal esophageal diverticulum

Pharyngopharyngeal diverticulum

Classification and etiology of pharyngopharyngeal diverticulum

Definition of pharyngoesophageal diverticulum

Pharyngopharyngeal diverticulum type

How esophageal diverticulum occurs

- Pharyngopharyngeal diverticulum-Clinical manifestations

Pharyngopharyngeal diverticulum symptoms and signs

Pharyngopharyngeal diverticulum clinical staging

- Pharyngopharyngeal diverticulum-Diagnosis

- Pharyngopharyngeal diverticulum-Examination

Pharyngopharyngeal diverticulum

Preoperative preparation of esophageal diverticulum

Pharyngoesophageal diverticulum anesthesia

Pharyngopharyngeal diverticulum surgery method

Postoperative Pharyngopharyngeal Diverticulum

Pharyngopharyngeal diverticulum structure diagram

- Pharyoesophageal diverticulum-Recovery and nursing

Multiple parts of pharyngeal esophageal diverticulum

Basopharyngeal diverticulum anatomy basis

Clinical manifestations of pharyngeal esophageal diverticulum

Diagnosis and diagnostic criteria of esophageal diverticulum and superior diverticulum

Treatment of esophageal diverticulum and supracondylar diverticulum

Related Papers on Pharyngopharyngeal Diverticulum

Overview of pharyngopharyngeal diverticulum surgery

Ultrasound diagnosis of pharyngeal esophageal diverticulum

X X-ray film of pharyngopharyngeal diverticulum

IN OTHER LANGUAGES

What Is Zenker's Diverticulum?

Pharyngeal esophageal diverticulum

Pharyngopharyngeal diverticulum

Classification and etiology of pharyngopharyngeal diverticulum

Definition of pharyngoesophageal diverticulum

Pharyngopharyngeal diverticulum type

How esophageal diverticulum occurs

- Pharyngopharyngeal diverticulum-Clinical manifestations

Pharyngopharyngeal diverticulum symptoms and signs

Pharyngopharyngeal diverticulum clinical staging

- Pharyngopharyngeal diverticulum-Diagnosis

- Pharyngopharyngeal diverticulum-Examination

Pharyngopharyngeal diverticulum

Preoperative preparation of esophageal diverticulum

Pharyngoesophageal diverticulum anesthesia

Pharyngopharyngeal diverticulum surgery method

Postoperative Pharyngopharyngeal Diverticulum

Pharyngopharyngeal diverticulum structure diagram

- Pharyoesophageal diverticulum-Recovery and nursing

Multiple parts of pharyngeal esophageal diverticulum

Basopharyngeal diverticulum anatomy basis

Clinical manifestations of pharyngeal esophageal diverticulum

Diagnosis and diagnostic criteria of esophageal diverticulum and superior diverticulum

Treatment of esophageal diverticulum and supracondylar diverticulum

Related Papers on Pharyngopharyngeal Diverticulum

Overview of pharyngopharyngeal diverticulum surgery

Ultrasound diagnosis of pharyngeal esophageal diverticulum

X X-ray film of pharyngopharyngeal diverticulum

IN OTHER LANGUAGES

RELATED ARTICLES

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