Pharyngeal pouch - Disorders of the oesophagus

Pharyngeal pouch

Definition

A false diverticulum arising at the junction of the oesophagus and the pharynx.

Aetiology/pathophysiology

In co-ordination between the contraction of the pharynx and relaxation of the upper oesophageal sphincter causes the pharyngeal mucosa to herniate posteriorly between the upper and lower fibres of the inferior constrictor muscle (Killian’s dehiscence).

Clinical features

Patients may present with a lump in the throat and dysphagia with regurgitation of undigested food some hours after eating. Complications include aspiration pneumonia, loss of weight and loss of appetite.

Management

A barium swallow will demonstrate the pouch. Diverticulectomy in which the pouch is excised and the defect repaired. Endoscopic techniques may be used in elderly patients, with a large dependent pouch, who are unfit for surgery.