Zenker's diverticulum is a very rare type of pathology of the digestive tract. This disease accounts for 3-5% of all cases. Outwardly, the pathology is manifested by a saccular protrusion of the mucous membrane of the esophagus and pharynx, it can have a different shape and size. The defect of the digestive tract initially occurs on its back wall, after which it reaches the side ones. Pharynoesophageal diverticulum is both a congenital and acquired disease, the development mechanism of which is most often pulsation, as it occurs in the weakest part of the organ due to increased pressure in its lumen.
Features of the disease
Zenker's diverticulum develops very slowly. Its dimensions can be different, reaching in some cases the size of the head of a newborn. The diverticulum has a neck and body covered with mucous epithelium. Its cavity may contain liquid, the volume of which can reach 1.5 liters.
It is locatedformation behind the esophagus and to the left of it, towards the upper mediastinum. Very rarely, an intramural form of pathology develops, when the diverticulum penetrates into the space between the muscles of the walls of the esophagus.
Reaching a large size, this formation begins to put pressure on the organs nearby. Such diverticula do not coalesce and do not cause inflammation in the surrounding tissues until peridiverticulitis develops.
Main causes of disease
During the normal process of swallowing food, contraction of the muscles of the pharynx occurs, the fibers of the cricopharyngeal muscle begin to relax, and the mouth of the esophagus opens. When muscle activity is disturbed, a diverticulum occurs.
The main causes of pathology are:
- hereditary predisposition;
- trauma of the esophageal mucosa;
- congenital diseases of muscle tissues;
- sclerosis and cartilage calcification;
- fetal development disorder;
- defects in muscle tissue;
- spinal injury;
- inflammatory diseases of the esophagus and pharynx.
Clinical manifestations of pathology
How does such a diverticulum manifest itself? It depends on its size. Small defects (up to 2 cm) do not manifest themselves in any way and are accidentally detected during radiographic or fluoroscopic examination.
If Zenker's 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 non-specific manifestations. These include: sore throat, profuse salivation or, conversely, dryness of the oral mucosa. Patients are haunted by unpleasant odors (rottenness, rottenness, hydrogen sulfide). An occasional cough or difficulty swallowing may occur. During a meal, there is an increase in tone, accompanied by tension in the muscles of the neck, as a result of which the patient feels a lump supposedly rolling up to the throat. After some time, the patient develops a lifestyle in which he does not notice a constant cough and belching and gets used to gargling after eating.
Features of the second and third stages
How does a diverticulum manifest itself in the second stage? This period is characterized by stagnation of mucus, food, accumulation of air, but the general state of he alth does not worsen. On examination, the doctor reveals the asymmetry of the neck due to one-sided protrusion. It is soft to the touch, disappears on palpation, and increases in size again during meals. During tapping on the center of the thickening after drinking a liquid, a splashing 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, the general state of he alth worsens significantly, the patient begins to lose weight dramatically.
Chronic inflammatory process occurring in the cavity of the diverticulum leads to various complications: pneumonia, asphyxia, abscesses, venous blood stasis, perforation of the esophageal walls, mediastinitis andthe occurrence of malignant neoplasms.
Diagnosis
The main method for diagnosing Zenker's diverticulum is X-ray, carried out in different planes. Special preparations stain the formation cavity, which makes it possible to determine not only the exact location, but also its size, shape, neck length, kinks along its length, the state of adjacent organs and anatomical structures. If a suspension of barium begins to linger in the cavity of the diverticulum, this indicates the development of diverticulitis.
Treatment of the disease with a conservative method
If Zenker's diverticulum is diagnosed, treatment is carried out both conservatively and surgically. But if in the first case the pathology is not eliminated, only surgery can help. Conservative therapy is resorted to only if there are serious contraindications to surgical intervention. In this case, the patient must adhere to a strict diet, soft diet, and careful chewing of food. After eating, the patient is drained of the diverticulum, for this he must lie in a certain position. In addition, such a formation is washed, and the patient should also take vegetable or vaseline oil to lubricate its walls.
Surgical treatment
Most often helps with a disease such as Zenker's diverticulum, an operation indicated in the second and third stagesdevelopment of the disease, accompanied by complications. 48 hours before surgery, the patient is given a liquid diet and the mass is thoroughly flushed through the esophagoscope or catheter.
With Zenker's diverticulum, the type of operation will be a one-stage diverticulectomy, which consists in removing the tissues of the sac of this formation through an incision. Before surgery, a thick probe is inserted into the esophagus to the patient, thereby facilitating the operation. The diverticulum isolated from the surrounding tissues is crossed at the base and sutured with a knotted or continuous suture. The pathological formation is removed with the help of a stapler, which is applied to its base.
Then, an extramucosal esophagomyotomy a few centimeters long is performed on the inserted probe. If the diverticula are small, only one cricopharyngeal myotomy is sufficient, after which they straighten and, together with the mucous membrane of the digestive tract, form a smooth wall.
Recently, some clinics have begun to perform endoscopic surgery, that is, without making an incision on the neck. Its essence is that a common wall is cut between the diverticulum and the esophagus and myotomy is performed using an endoscopic stapler. After such an operation, the patient recovers much faster, and the number of complications is also reduced.
Postoperative period after removal of Zenker's diverticulum
Features of this period arethat the patient should not eat for 48 hours. Some surgeons leave the tube for 3-4 days to feed the patient with liquid food. After its extraction, 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.
Conclusion
Thus, Zenker's diverticulum is a very insidious disease. Not manifesting itself at the very beginning of its development, after a while it significantly worsens the state of he alth. It should be treated without fail, because there is a high probability of death from various complications.
