Zenker's diverticulum: how is manifested, treatment, operation

Zenker's diverticulum is a very rare type of pathology of the digestive tract. This disease accounts for 3-5% of all cases. Externally, the pathology manifests itself as saccular protrusion of the mucous membrane of the esophagus and pharynx, can have a different shape and magnitude. The defect of the digestive tract initially arises on its back wall, and then reaches the lateral ones. The pharyngeal esophageal diverticulum is both an innate and acquired disease, the development mechanism of which is most often pulsed, since it arises in the weakest place of the organ due to the increased pressure in its lumen.

Features of the disease

The development of Zenker's diverticulum is very slow. Its dimensions can be different, reaching in some cases the size of the head of the newborn. The diverticulum has a cervix and a body covered with a mucous epithelium. In its cavity may be a liquid, the volume of which is capable of reaching 1.5 liters.

This formation is located behind the esophagus and to the left of it, towards the upper mediastinum. Very rarely develops an intramural form of pathology, when the penetration of the diverticulum occurs in the space between the muscles of the walls of the esophagus.

Reaching a large size, this formation begins to exert pressure on the organs that are near. Such diverticula do not coalesce and do not cause inflammation in the surrounding tissues until the peridiverticulitis develops.

The main causes of the disease

With the normal process of swallowing food, there is a contraction of the muscles of the pharynx, the fibers of the cricopharyngeal muscle begin to relax, and the mouth of the esophagus opens. When there is a violation of the muscles, a diverticulum occurs.

The main reasons for the formation of pathology are:

• Hereditary predisposition;
• Trauma of the mucosa of the esophagus;
• Congenital diseases of muscle tissues;
• Sclerosis and calcification of cartilage;
• Violation of intrauterine development;
• Defects in muscle tissue;
• Trauma of the spine;
• Inflammatory diseases of the esophagus and pharynx.

Clinical manifestations of pathology

How is this diverticulum manifested? It depends on its size. Defects are small (Up to 2 cm) do not manifest themselves in any way and are accidentally detected during X-ray or X-ray examination.

If there was a Zenker diverticulum, the symptoms of this disease are divided according to the stages of the disease.

Features of the first stage

Nonspecific manifestations are characteristic of the first stage. To them carry: pershenie in a throat, plentiful allocation of a saliva or, on the contrary, dryness of a mucous cavity of a mouth. Patients are haunted by unpleasant smells (rot, rottenness, hydrogen sulphide). A rare cough or difficulty swallowing may occur. During meals, there is an increase in tone, accompanied by tension in the muscles of the neck, as a result of which the patient feels how the lump is supposedly rolled up by a lump. After a while the patient develops a lifestyle in which he does not notice a constant cough and eructation and gets used to gargling after eating.

Features of the second and third stages

How does the diverticulum manifest in the second stage? This period is characterized by stagnation of mucus, food, accumulation of air, but overall health does not deteriorate. On examination, the doctor reveals the asymmetry of the neck due to unilateral protrusion. It feels soft to the touch, disappears when palpation, and again increases in size during meals. During the tapping in the center of the thickening after the use of the fluid there is a symptom of splashing, and with lateral pressure there is a rumbling.

At the third stage, decompensation of the disease is noted. The manifestation of symptoms becomes more pronounced, the general state of health worsens considerably, the patient begins to lose weight sharply.

The chronic inflammatory process that occurs in the cavity of the diverticulum leads to various complications: pneumonia, asphyxia, abscesses, stagnation of venous blood, perforation of the esophagus walls, mediastinitis and the appearance of malignant neoplasms.

Diagnostics

The main method, which allows to diagnose Zenker's diverticulum, is an x-ray, conducted in different planes. Special preparations stain the cavity of formation, so that it becomes possible to determine not only the exact location, but also its size, shape, length of the neck, kinks along its length, the condition 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 the zenker's diverticulum is diagnosed, the treatment is performed both conservatively and surgically. But if in the first case the pathology is not eliminated, only the operation will be able to help. To conservative therapy resorted only in the event that there are serious contraindications to surgical intervention. In this case, the patient must adhere to a strict food regime, a mild diet, a thorough chewing of food. The patient after a meal is drained of the diverticulum, for this he must lie in a certain position. In addition, this formation is washed, and the patient should also take vegetable or petrolatum oil to lubricate its walls.

Surgery

Most often it helps with a disease such as Zenker's diverticulum, an operation performed during the second and third stages of the development of the disease, accompanied by complications. 48 hours before the surgery, the patient is prescribed a liquid diet and thoroughly washed such an esophagoscope or catheter.

With Zenker's diverticulum, the kind of surgery will be a one-stage diverticuloectomy, which consists in removing the tissues of the bag of this formation through the incision. Before surgery, the patient is injected with a thick probe into the esophagus, thereby facilitating the operation. Divided from surrounding tissues, the diverticulum is crossed at the base and sewn with a knotty or continuous suture. The pathological formation is removed by means of a stapling apparatus, which is applied to its base.

Then, on the inserted probe, an extra-mucosal esophagomyotomy is made several centimeters long. If the diverticula are small, only one cryopharyngeal myotomy is sufficient, after which they spread out and together with the mucous membrane of the digestive tract constitute a flat wall.

Recently, some clinics began to perform the operation endoscopically , that is, without making a cut on the neck. Its essence is that the common wall is divided between the diverticulum and the esophagus and the myotomy is performed with the help of an endoscopic stapler. After such an operation, the patient is restored much faster, and the number of complications decreases.

Postoperative period after removal of the Center diverticulum

The peculiarities of this period are that a patient of 48 hours can not eat. Some surgeons leave the probe for 3-4 days to feed the patient with liquid food. After its extraction on 5-6 days they give already semi-liquid food, gradually expanding the diet.

If you do not treat this disease, then the forecast is extremely unfavorable. Various complications result in a lethal outcome 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 health. It is necessary to treat it, because the probability of a lethal outcome from various complications is high.