Usually there are no clinical signs but there may be a lump in the neck that gurgles on palpation. There may also be halitosis from food decaying in the pouch.
A pharyngeal pouch(Zenkers diverticulum) represents a posteromedial pulsion diverticulum through Killian's dehiscence. It is a herniation between the thyropharyngeus and cricopharyngeus muscles that are both part of the inferior constrictor of the pharynx.
The aetiology is unknown but malfunction of the upper oesophageal sphincter probably contributes. They occur in the elderly.
The diagnosis is confirmed with a Barium swallow.
traditionally we have treated these by an external operation which involves exposing the pouch in the neck and excising it. As we don't see too many of these it can be a difficult procedure with some risks.
Recent endoscopic techniques are now favoured so we asked a specialist colleague to come from Auckland to show us how it is done.
The video shows the dividing wall between the pouch and the oesophagus being divided. We used a harmonic scalpel which seals and cuts the bridge which includes the cricopharyngeus muscle creating a single large cavity.
No comments:
Post a Comment