Esophageal Diverticula

• Almost all esophageal diverticula are associated with esophageal motor disorders

• Pulsion diverticula contain no muscle in their wall so they tend to stay filled with barium after the rest of the esophagus empties

• Traction diverticula contain muscle in their walls so they tend to empty with the rest of esophagus

Zenker’s diverticulum (pharyngoesophageal tic)

• Pulsion diverticulum with herniation of mucosa and submucosa through oblique and transverse muscle bundles of the cricopharyngeal muscle (pseudodiverticulum)

• Cricopharyngeal dysfunction results in increased intraluminal pressures and tic formation in midline of Killian dehiscence at level of C5-C6

• Symptoms

• Dysphagia

• Regurgitation of food

• When large enough, may compress lumen and cause obstruction

X-ray

• Barium-filled sac arising posterior and usually to the left of esophagus

• Reflux from tic into hypopharynx

Traction diverticulum (interbronchial diverticulum)

• Response to pull from fibrous adhesions following lymph node infection (almost always TB)

• Contains all three esophageal layers

• Usually located on right anterior wall

Epiphrenic diverticulum

• Usually on lateral distal esophageal wall; right greater than left

• Often associated with hiatal hernia

• Pulsion diverticulum

Interaortico-bronchial diverticulum

• Pulsion diverticulum

• Occurs on left anterolateral wall between the inferior border of the aortic arch and upper margin of left mainstem bronchus

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