Modified Mondays: Zenker's Take Three
I know I have shared two other great examples of Zenker’s diverticulum (diverticuli?) lately, but this one allowed me to point out a whole new take on an old problem. As stated before, Zenker’s develop in a certain area because of a tiny triangle of relative weakness (known as the Killian’s triangle) in the posterior pharyngeal wall. They can be repaired by either removing and stitching shut, or by simply stitching the opening shut. However, the weakness is still there, plus we’ve increased the weakness in the process of repair, so it’s not uncommon for them to actually reappear.
This particular patient had a Zenker’s repair six years prior to this study (pouch was removed and then stitched shut). Patient had a recent onset of symptoms, including coughing after swallows, and complaining of solids “stuck”. The daughter was able to be present, and voiced concerns that the Zenker’s had reoccurred…and she was unfortunately correct.
This case highlights the importance of thoroughly examining the patient’s medical/surgical history. The Zenker’s was a little difficult to visualize with certainty on the lateral plane, but because our SLP was aware of the surgical history (as well as the information gathered when she spoke to the daughter), she knew the importance of obtaining the A-P view to fully assess.
Click the links below for more information on Zenker’s and their recurrence!