A 68-year-old man reports progressive dysphagia, regurgitation of undigested food eaten hours earlier, gurgling sounds during swallowing, halitosis, and a soft swelling low in the left side of the neck that reduces after meals. Barium swallow shows an outpouching below the level of the cricoid cartilage. The herniation occurs through a weak area bounded above by the oblique fibres of the thyropharyngeus and below by the transverse fibres of the cricopharyngeus known as:

• A Thomson's fissure
• B Laimer's triangle
• C Dehiscence of the inferior constrictor
• D Killian's dehiscence ✓

Explanation

Zenker's (pharyngeal) pouch is a pulsion diverticulum of the hypopharynx herniating through Killian's dehiscence, the gap between the oblique thyropharyngeus and the transverse cricopharyngeus fibres of the inferior constrictor. Incoordination of cricopharyngeal relaxation raises intrapharyngeal pressure and drives mucosa through this weak point. Laimer's triangle lies more distally between the cricopharyngeus and the oesophageal longitudinal fibres and is not the classical site.

Reference: Diseases of Ear, Nose and Throat (Dhingra), 7th ed.

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Written and medically reviewed by the StethoPrep medical team.