An elderly man with dysphagia regurgitates undigested food eaten hours earlier, with halitosis and recurrent nocturnal coughing. Barium swallow shows a pouch arising posteriorly above the cricopharyngeus. At which anatomical site does this diverticulum develop?

• A Laimer triangle below the cricopharyngeus
• B Killian dehiscence between thyropharyngeus and cricopharyngeus ✓
• C Right lateral wall at the level of the aortic arch
• D Epiphrenic region just above the diaphragmatic hiatus

Explanation

Zenker diverticulum is a pulsion diverticulum herniating through Killian dehiscence, the weak area between the oblique fibres of thyropharyngeus and the transverse cricopharyngeus, caused by cricopharyngeal incoordination. Laimer triangle lies below the cricopharyngeus and is a rare site, epiphrenic diverticula occur low above the diaphragm, and the aortic arch level describes mid-oesophageal traction diverticula.

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

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Written and medically reviewed by the StethoPrep medical team.