Etiology and Pathology
The condition arises due to the presence of a weak triangular area between the inferior constrictor muscle and the cricopharyngeus muscle. When there is uncoordinated muscle activity during swallowing, with the inferior constrictor contracting to propel food downward and the cricopharyngeus failing to relax or prematurely contracting, the esophageal mucosa protrudes through the weak area. This forms a pulsion-type pseudodiverticulum.
Clinical Manifestations
No symptoms are observed in early stages. As the diverticulum enlarges, gurgling sounds may occur during swallowing. Retention of food within the diverticulum can lead to a sensation of neck compression. Decomposing and fermenting retained food may produce a foul odor and cause inflammation and swelling of the mucosa, resulting in dysphagia. In some cases, a soft, compressible mass may be palpable in the neck, which may produce gurgling sounds upon compression. Large diverticula may compress the recurrent laryngeal nerve, causing hoarseness. Aspiration of regurgitated food into the lungs may lead to pulmonary infections as a complication.
Diagnosis
Esophagography with barium swallow or chest CT scanning can confirm the diagnosis. These imaging studies reveal the location, size, and site of connection of the diverticulum.
Treatment
Symptomatic patients may undergo surgical excision of the diverticulum. The esophageal wall incision may be closed via layered suturing or stapled using surgical instruments. For patients who are not suitable candidates for surgery due to their general condition, pressing the diverticulum during meals can help reduce food retention. Additionally, rinsing the diverticulum with warm water after eating can help remove food residues.