Abstract
The aetiopathogenesis of pharyngeal pouch remains obscure. This review highlights the associations and complications of pharyngeal pouch to better understand the pathogenesis and management of the pouch. A search of the MEDLINE was conducted to identify studies that looked at associations and/or complications of the pharyngeal pouch. The Medical Subject Headings (MeSH) included Zenker’s diverticulum and hypopharyngeal diverticulum. A total of 64 papers were included for the analysis. They consisted mainly of single case reports, case series and review articles and one case control study. A summary of evidence from the literature is discussed. This review shows the various associations and complications that can occur with pharyngeal pouches. It is important to be aware that pharyngeal pouch can co-exist with other pathologies and treatment needs to be altered to incorporate the treatment of the associated pathology too. Surgeons should also be aware of the complications that can occur within and outside the pouch.
Similar content being viewed by others
References
Chitwood AR (1979) Ludlow’s esophageal diverticulum: a preternatural bag. Surgery 85:549–553
Zenker FA, von Ziemssen. Krankheiten des oesophagus In: Von Ziemssen H (1877) Handbuch der speziellen Pathologie und Therapie 7:30q. C. Vogel, Leipzig
Killian G (1907) The mouth of the oesophagus. Laryngoscope 17:421–428
Bradley PJ, Kochaar A, Quraishi MS (1999) Pharyngeal pouch carcinoma: real or imaginary risks? Ann Otol Rhinol Laryngol 108:1027–1032
Gregoire J, Duranceau A (1992) Surgical management of Zenker’s diverticulum. Hepatogastroenterology. 39:132–138
Sutherland HD (1962) Cricopharyngeal achalasia. J Thorac. Cardiovas Surg 43:114–126
Belsey R (1966) Functional disease of the esophagus. J Thorac Cardiovasc Surg 52:164–188
Negus VE (1959) Pharyngeal diverticula. Observations on their evolution and treatment. Br J Surg 38:129–146
Bell C (1816) Surgical observations. Longmans, Greece & Co, London, pp 64–70
van Overbeek JJ (2003) Pathogenesis and methods of treatment of Zenker’s diverticulum. Ann Otol Rhinol Laryngol 112:583–593
Barclay AE (1932) Der normale schlingmechanisms. Acta Radiol 13:91–110
Cook IJ, Gabb M, Panagopoulos V, Jamieson GG, Dodds WJ, Dent J, Shearman DJ (1992) Pharyngeal (Zenker’s) diverticulum is a disorder of upper esophageal sphincter opening. Gastroenterology 103:1229–1235
Cook IJ, Blumbergs P, Cash K, Jamieson GG, Shearman DJ (1992) Structural abnormalities of the cricopharyngeus muscle in patients with pharyngeal (Zenker’s) diverticulum. J Gastroenterol Hepatol 7:556–562
Nelson AR (1957) Congenital true oesophageal diverticulum of the posterior hypopharynx. Report of a case unassociated with other oesophagotracheal abnormality. Ann Surg 145:258–264
Britnall ES, Kridelbaugh WW (1950) Congenital diverticulum of the posterior hypopharynx, simulating atresia of the oesophagus. Ann Surg 131:564–574
Groves LK (1978) Pharyngoesophageal diverticulum in each of the three sisters. Report of cases.Cleveland Clin Q 35:207–214
Bjork H (1952) Pathogenesis of hypopharyngeal diverticulum with special reference to hereditary. Acta Otolaryngol 42:202–207
Westrin KM, Ergun S, Carlsoo B (1996) Zenker’s diverticulum—a historical review and trends in therapy. Acta Otolaryngol 116:351–360
Stafford ND, Moore-Gillon V, McKelvie P (1984) Handedness and the side on which pharyngeal pouches occur. Br Med J (Clin Res Ed) 288:815–816
Shallow TA, Clerf LH (1948) One stage pharyngeal diverticulectomy. J Surg Gynaecol Obstet 86:317–322
Jesberg N (1954) Bilobed pulsion diverticulum of the hypopharynx; a historical summary and a case report. Ann Otol Rhinol Laryngol 63:39–50
Izzat AB, Dezso A, Hardingham M (2000) Bilobed pharyngeal pouch: a very rare finding. J Laryngol Otol 114:802–804
Stafford N, Frootko N (1987) Double pharyngeal pouch. Ann Otol Rhinol Laryngol 96:127
Meehan T, Henein RR (1992) An unusual pharyngeal pouch. J Laryngol Otol 106:1002–1003
Harrington SW (1945) Pulsion diverticulum of the hypopharynx at the pharyngo-oesophageal junction. Surgery 18:66–81
Birt BD (1985) Dysphagia due to simultaneous laryngocele and Zenker’s diverticulum. Laryngoscope 95:1–2
Weaver DS, Johnson EE (1967) Benign esophageal tumor. Case report with endoscopic removal associated with a Zenker’s diverticulum. Gastrointest Endosc 14:124–126
Georgalas C, Baer ST (2000) Pharyngeal pouch and polymyositis: association and implications for aetiology of Zenker’s diverticulum. J Laryngol Otol 114:805–807
Mercer CD, Hill LD (1985) Esophageal web associated with Zenker’s diverticulum: a possible cause of continuing dysphagia after diverticulectomy. Can J Surg 28:375–376
Low DE, Hill LD (1988) Cervical esophageal web associated with Zenker’s diverticulum. Am J Surg 156:34–37
Shotton JC, Russell GA, Milton CM, Sergeant RJ (1993) Extra-pharyngeal neck pathology complicating pharyngeal pouch surgery. J Laryngol Otol 107:1163–1164
Nunez DA, Lang W, Pollock JG (1989) Associated carotid body tumor and pharyngeal pouch. J Laryngol Otol 103:531–532
Sood S, Henein RR, Girgis B (1998) Pharyngeal pouch following anterior cervical fusion. J Laryngol Otol 112:1085–1086
Salam MA, Cable HR (1994) Acquired pharyngeal diverticulum following anterior cervical fusion operation. Br J Clin Pract 48:109–110
Skinner EF, Page G (1958) Esophago-diverticulostomy for stenosis of upper esophagus associated with Zenker’s diverticulum. Am Surg 24:806–810
Ponzoli VA Jr (1968) Zenker’s diverticulum: a review of pathogenesis and presentation of 25 cases. South Med J 61:817–821
Smiley TB, Caves PK, Porter DC (1970) Relationship between posterior pharyngeal pouch and hiatus hernia. Thorax 25:725–731
Gage-white L (1988) Incidence of Zenker’s diverticulum with hiatus hernia. Laryngoscope 98:527–30
Resouly A, Braat J, Jackson A, Evans H (1994) Pharyngeal pouch: link with reflux and oesophageal dysmotility. Clin Otolaryngol 19:241–242
Delahunty JE, Margulies SI, Alonso WA, Knudson DH (1971) The relationship of reflux esophagitis to pharyngeal pouch (Zenker’s diverticulum) formation. Laryngoscope 81:570–577
Hunt PS, Connell AM, Smiley TB (1970) The cricopharyngeal sphincter in gastric reflux. Gut 11:303–306
Sasaki CT, Ross DA, Hundal J (2003) Association between Zenker diverticulum and gastroesophageal reflux disease: development of a working hypothesis. Am J Med 115 [Suppl 3A]:169S–171
Scher RL, Richtsmeier WJ (1996) Endoscopic staple-assisted esophagodiverticulostomy for Zenker’s diverticulum. Laryngoscope 106:951–956
Koay CB, Bates GJ (1996) Endoscopic stapling diverticulotomy for pharyngeal pouch. Clin Otolaryngol 21:371–376
Feussner H, Siewert JR (1992) Zenker’s diverticulum and reflux. Hepatogastroenterology 39:100–104
Tsai CJ (1994) Bezoar in a Zenker’s diverticulum. Am J Gastroenterol 89:944–946
Tolliver BA, DiPalma JA (1955) Zenker’s bezoar. South Med J 88:751–752
Senders CW, Babin RW (1983) Management of benign fistulae between Zenker’s Diverticulum and the trachea. Ann Otol Rhino Laryngol 92:349–352
Frot-Martin B, Carlier RY, Morand-Blot V, Faye A, Bernard L, Vallee C (2001) Zenker’s diverticulum associated with multilevel cervical osteomyelitis. Spine 26:E193–197
Case records of the Massachusetts General Hospital Case 38042 (1950) N England J Med 242:152
Shirazi KK, Daffner RH, Gaede JT (1977) Ulcer occurring in Zenker’s diverticulum. Gastrointest Radiol 25:117–118
Vaghei R, Harrison I, Ortiz RA (1976) Massive bleeding from the pharyngoesophageal diverticulum. Am Surg 42:917–919
Bowdler DA, Stell PM (1987) Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker’s diverticulum). Br J Surg 74:561–563
Lieberson M, Reise KT (1960) Carcinoma in a large pharngoesophageal diverticulum. Gastroenetrology 38:817–820
Fischer MJ, Bond JF (1967) Carcinoma in a pharyngoesophageal diverticulum. J Thorac Cardiovasc Surg 53:500–503
Author information
Authors and Affiliations
Corresponding author
Additional information
None of the authors have any financial interest in this study.
Rights and permissions
About this article
Cite this article
Sen, P., Kumar, G. & Bhattacharyya, A.K. Pharyngeal pouch: associations and complications. Eur Arch Otorhinolaryngol 263, 463–468 (2006). https://doi.org/10.1007/s00405-005-1036-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-005-1036-9