A 68-year-old man complains of difficulty initiating swallowing, regurgitation of foul-tasting undigested food eaten hours earlier, gurgling sounds in the neck on swallowing, and a soft reducible swelling behind the left sternocleidomastoid. Which statement about this condition is correct?

• A It is a traction diverticulum arising through Killian's dehiscence
• B It is a congenital outpouching communicating with the trachea
• C It results from weakness at the junction of the thyropharyngeus and cricopharyngeus on the right side
• D It is a pulsion diverticulum arising between the oblique fibres of the thyropharyngeus and the transverse fibres of the cricopharyngeus ✓

Explanation

This is a pharyngeal (Zenker's) pouch, a pulsion diverticulum caused by neuromuscular incoordination of the cricopharyngeus, herniating through Killian's dehiscence, the weak area between the oblique thyropharyngeus and transverse cricopharyngeus fibres on the midline posterior wall. It is acquired, not congenital or traction-type (traction pouches are lower, at the midesophagus). Treatment is division of the cricopharyngeus with excision or suspension of the sac.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.