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Radiographic Findings and Complications After Surgical or Endoscopic Repair of Zenker's Diverticulum in 16 Patients

Brian D. Sydow1, Marc S. Levine, Stephen E. Rubesin and Igor Laufer

1 All authors: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104.



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  		Fig. 1A. —73-year-old man with remnant diverticulum after endoscopic stapling diverticulotomy for dysphagia. Steep oblique view from preoperative barium study shows 3-cm Zenker's diverticulum (white arrow) above prominent cricopharyngeus (black arrow).

 


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  		Fig. 2A. —80-year-old man with suspended diverticulum after diverticulopexy and cricopharyngeal myotomy for dysphagia. Lateral view from preoperative barium study shows 3-cm Zenker's diverticulum (arrow).

 


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  		Fig. 3. —77-year-old woman with unsuspected leak 1 week after diverticulectomy and cricopharyngeal myotomy for dysphagia. Steep oblique view from radiographic study with water-soluble contrast material shows 4-cm, irregular, blind-ending tract (arrows) posterior to pharyngoesophageal segment in prevertebral space.

 


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  		Fig. 4A. —44-year-old man with transient pharyngeal dysfunction after open diverticulectomy and cricopharyngeal myotomy for dysphagia. Lateral spot view from barium study 5 weeks after surgery shows marked pharyngeal paresis with retention of barium in hypopharynx and aspirated barium in larynx and trachea (arrow).

 


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  		Fig. 4B. —44-year-old man with transient pharyngeal dysfunction after open diverticulectomy and cricopharyngeal myotomy for dysphagia. Lateral spot view from repeated barium study 4 weeks later shows improved emptying of hypopharynx and only minimal penetration of barium into larynx (arrows), so marked improvement in swallowing function has occurred in interim.

 


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  		Fig. 1B. —73-year-old man with remnant diverticulum after endoscopic stapling diverticulotomy for dysphagia. Steep oblique view from repeat barium study 2 months after diverticulotomy shows 1-cm remnant diverticulum (straight arrow) in same location above prominent cricopharyngeus (curved arrow). Note retention of barium in diverticulum.

 


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  		Fig. 2B. —80-year-old man with suspended diverticulum after diverticulopexy and cricopharyngeal myotomy for dysphagia. Lateral radiograph with water-soluble contrast material and barium 2 days after surgery, shows 2-cm diverticulum, which has been suspended from posterior aspect of pharyngoesophageal segment so that base of diverticular sac (straight arrow) is located above orifice (curved arrow). Note how contrast material has emptied from diverticulum.

 


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  		Fig. 2C. —80-year-old man with suspended diverticulum after diverticulopexy and cricopharyngeal myotomy for dysphagia. Lateral view from repeat barium study 6 months after surgery shows 1-cm suspended diverticulum (arrow), which has contracted considerably since earlier postoperative study.

 


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  		Fig. 5. —61-year-old man with mucosal beaking after endoscopic stapling diverticulotomy for dysphagia. Lateral radiograph with water-soluble contrast material and barium 9 days after procedure shows tenting of posterior aspect of pharyngoesophageal segment (white arrow) just above prominent cricopharyngeus (black arrow), which fails to relax normally during swallowing.

 

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