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Zenker's diverticulum misinterpreted as a thyroid mass: Case report.

ABSTRACT: We discuss an unusual presentation of Zenker's Diverticulum (ZD). A 76-year-old man presented with a left sided neck mass which was misdiagnosed as a thyroid mass due to the anatomical location and size. The ultrasound and fine needle-aspiration cytology findings were inconclusive, and a CT scan was then considered which reported a large pharyngeal pouch. Our recommendation is to consider an early CT scan in patient's where there is a clinical suspicion or risk factors for the development of pharyngeal pouch specially when the fine-needle aspiration cytology findings are inconclusive. This would reduce the risk of a delayed diagnosis which can prevent potential perforation of the pharyngeal pouch and development of mediastinitis.

SUBMITTER: Salimi F

PROVIDER: S-EPMC7695926 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Zenker's diverticulum: advancing beyond the tunnel.

Project description:Background and aimsZenker's diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions.MethodsWe review the rationale and key technique for various endoscopic treatment modalities for ZD, cricopharyngeal bar, and other esophageal diverticula.ResultsStandard flexible endoscopic cricopharyngeal myotomy involves the division of the common wall or septum of the ZD, aiming for complete transection of the cricopharyngeus. However, recurrence rates are high, likely owing to incomplete myotomy. Zenker's peroral endoscopic myotomy (Z-POEM) uses a proximal submucosal tunnel to provide direct visualization of the cricopharyngeus and septum, allowing confirmation of complete myotomy. We demonstrate an over-the-septum modification to simplify the technique. Submucosal fibrosis, commonly seen in patients with prior treatment, limits submucosal dissection. We present a hybrid technique to overcome this, whereby a traditional septotomy is performed until submucosal tissue is visualized. The intact mucosal flap after Z-POEM in a large ZD may contribute to residual dysphagia. We propose Z-POEM with mucosotomy for large ZD. Finally, we demonstrate modifications for treatment of other esophageal diseases, including cricopharyngeal bar and non-Zenker's esophageal diverticula.ConclusionEndoscopic treatment options for ZD and related conditions are rapidly expanding. With careful tailoring to individual patient characteristics, our expanding arsenal of options allows effective and safe treatment of a broad spectrum of patients.

| S-EPMC8646134 | biostudies-literature

Peroral endoscopic myotomy for a residual Zenker's diverticulum following endoscopic myotomy.

Project description:Video 1Peroral endoscopic myotomy for a residual Zenker's diverticulum following endoscopic myotomy.

| S-EPMC8755520 | biostudies-literature

Sonographic Detection of a Torsed Meckel's Diverticulum Misinterpreted as Acute Appendicitis.

Project description:A 38-year-old female presented to the emergency department (ED) with acute-onset right lower quadrant abdominal pain following two days of nausea and vomiting. Physical examination revealed right lower quadrant tenderness to palpation, rebound tenderness, and guarding. Point-of-care ultrasound (POCUS) of the right lower abdomen was performed and interpreted as probable appendicitis. However, upon laparoscopic examination of the abdomen, a benign-appearing appendix was visualized. Further investigation revealed the source of the patient's pain to be a torsed Meckel's diverticulum. Although rare, a torsed and inflamed Meckel's diverticulum can be visualized by POCUS in the ED without the need for further imaging or delay.

| S-EPMC6682254 | biostudies-literature

Management of Zenker's diverticulum using flexible endoscopy.

Project description:Background and Aims:Zenker's diverticulum is a false diverticulum through Killian's dehiscence. Symptoms include halitosis, dysphagia, regurgitation, cough, and aspiration pneumonia. Treatment options include open transcervical cricopharyngeal myotomy, trans-oral rigid endoscopic stapling, and minimally invasive endoscopic myotomy. Although open surgical techniques have historically been the criterion standard for treatment, endoscopic options have become increasingly used. We propose the use of flexible endoscopy in the management of Zenker's diverticulum. Methods:We present a retrospective case series of 9 patients undergoing endoscopic cricopharyngeal myotomy from 2014 to 2018 using our endoscopic technique. Results:We demonstrate that endoscopic technique provided adequate symptomatic relief in 7 of 9 patients, with no operative adverse events. Conclusions:Cricopharyngeal myotomy using flexible endoscopy is a safe and effective technique for the management of Zenker's diverticulum. Potential benefits of this approach include shorter operative times, shorter postoperative admissions, and earlier progression of diet. Initial treatment with endoscopic technique does not preclude future open repairs.

| S-EPMC6363821 | biostudies-other

Peroral Endoscopic Myotomy in the Management of Zenker's Diverticulum: A Retrospective Multicenter Study.

Project description:BackgroundPeroral endoscopic myotomy (POEM) is an emerging technique in the treatment of Zenker's diverticulum (ZD). This study aimed to analyze the feasibility of Zenker's POEM (Z-POEM) in a multicenter setting and assess its performance using a validated Kothari-Haber Scoring System newly developed for symptom measurement in ZD.Materials and methodsThis was a multicenter retrospective study involving three Polish tertiary referral endoscopic units. The data of consecutive patients with symptomatic ZD treated with Z-POEM in Poland between May 2019 and August 2020 were retrieved and analyzed. Primary outcome measures were technical success and clinical success rate (<3 points in Kothari-Haber Score at 2-3 months follow-up). Secondary outcome measures included procedures' duration, length of hospital stay, and adverse events.Results22 patients with symptomatic ZD were included. The mean age was 67.6 (±10.7) years, and 14 (63.6%) were male. All but two patients were treatment naïve. The average size of the ZD was 30 mm (IQR, 24-40 mm). Technical success was achieved in all patients (100%), whereas clinical success was 90.9%. The average Kothari-Haber Score was 6.35 before treatment and has dropped to 0.65 after the treatment (p < 0.0001). The mean procedure time was 48.8 (±19.3) minutes, and the median length of hospital stay was 2 days (IQR, 2-3). Three patients (13.6%) had post-procedural emphysema, of which two were mild and self-resolving (9.1%), and one was moderate (4.5%) and complicated with laryngeal edema and prolonged intubation.ConclusionsThis feasibility study suggests that Z-POEM is a highly effective and safe treatment for ZD, particularly among treatment-naïve patients. Comparative studies with other treatment modalities over longer follow-up are warranted.

| S-EPMC7826711 | biostudies-literature

Zenker's diverticulum complicating achalasia: a 'cup-and-spill' oesophagus.

Project description:A 72-year-old woman presented with long-standing gastro-oesophageal reflux, regurgitation of swallowed food and worsening cervical dysphagia. Fluoroscopic barium oesophagography revealed a posterolateral pharyngeal pouch (Zenker's diverticulum (ZD)) complicating a 'cup and spill' oesophageal deformity with a smoothly tapered segment at the gastro-oesophageal junction. CT and high-resolution manometry confirmed that the underlying abnormality was a massively dilated oesophagus with aperistalsis and pan-oesophageal pressurisation, consistent with a diagnosis of oesophageal achalasia (type II). She underwent endoscopic stapled diverticulotomy, with good symptomatic relief. We discuss the aetiology of ZD, its management and the association here with oesophageal achalasia.

| S-EPMC3863039 | biostudies-other

A rare case of idiopathic congenital megaduodenum in adult misinterpreted during childhood: case report and literature review.

Project description:Intestinal malformations are common disorders in newborn and favorable outcomes have been reported for such conditions. Although, if the patient is treated in a not experienced center, misinterpretation of the clinical and radiological findings may lead to errors in treatment and possible complications in adulthood. We report a case of a congenital megaduodenum which was misinterpreted as an intestinal malrotation resulting in late complications. The patient underwent a successful surgical resection of the duodenum with improvement of his clinical symptoms and nutritional status. This case report emphasizes the importance of considering megaduodenum in the differential diagnosis of patients with feeding impairment, even during adulthood. Early diagnosis and treatment may improve patients' outcome and reduce morbidity.

| S-EPMC6514750 | biostudies-literature

Endoscopic suturing for repair of an obstructing Zenker's diverticulum using a bidirectional endoscopic approach for lumen delineation.

Project description:Video 1Endoscopic suturing of an obstructing Zenker's diverticulum.

| S-EPMC9263871 | biostudies-literature

Zenker's Diverticulum: Can Protocolised Measurements with Barium SWALLOW Predict Severity and Treatment Outcomes? The "Zen-Rad" Study.

Project description:Although barium swallow imaging is established in the investigation of Zenker's diverticulum (ZD), no agreed measurement protocol exists. We developed a protocol for measuring ZD dimensions and aimed to correlate measurements with symptoms and post-operative outcomes. This prospective study included patients with confirmed ZD who underwent flexible endoscopic septal division (FESD) between 2014 and 2018. ZD was confirmed on barium radiology with measurements reviewed by two consultant radiologists. Symptom severity pre- and post-FESD was measured using the Dysphagia, Regurgitation, Complications (DRC) scale. Regression analyses were conducted to identify dimensions associated with therapeutic success, defined as remission (DRC score ≤ 1) 6 months after index FESD. In total, 67 patients (mean age 74.3) were included. Interobserver reliability (intraclass correlation coefficients-ICCs) was greatest for pouch width (0.981) and pouch depth (0.934), but not oesophageal depth (0.018). Male gender (60.9%) was associated with larger pouch height (P = 0.008) and width (P = 0.004). A positive correlation was identified between baseline DRC score and pouch depth (ρ 0.326, P = 0.011), particularly the regurgitation subset score (ρ 0.330, P = 0.020). The index pouch depth was associated with FESD procedure time (rho 0.358, P = 0.041). Therapeutic success was achieved in 64.2% and was associated with shorter pouch height (median 14.5 mm vs. 19.0 mm, P = 0.030), pouch width (median 19.9 mm vs. 28.8 mm, P = 0.34) and cricopharyngeal length (median 20.2 mm vs. 26.3 mm, P = 0.036). ZD dimensions may be feasible and were evaluated using Barium radiology. Specific parameters appear to correlate with severity and post-FESD outcomes, which aid with pre-procedural planning.

| S-EPMC8163680 | biostudies-literature