Synonyms
Zenker’s diverticula, emulsion diverticula, traction diverticula, hypopharyngeal diverticula, cervical diverticula, esophageal sacking Medical: esophageal diverticula
Definition
Diverticula are congenital or acquired protrusions of wall parts of a hollow organ (esophagus, intestine, bladder). Diverticula can occur throughout the entire digestive tract. They are most frequently found in the large intestine (diverticulosis), but they can also be found in the esophagus.
Oesophageal diverticula (esophageal diverticula) is the term used to describe a bulge in the wall of the oesophagus. There are different types of diverticula, depending on which layers of the esophageal wall are involved in the formation of diverticula. A distinction is made between traction diverticula (“true” diverticula) and pulsation diverticula (“false” diverticula).
Epidemiology
Esophageal diverticulum (esophageal diverticulum) is a rare disease, but the risk of developing the disease increases with age. 80% of those affected are men, two thirds of whom are older than 70 years. The most common diverticulum is the Zenker’s diverticulum with about 70%, followed by the parabrochial diverticulum with about 21%.
Epiphrenal diverticula are less common in about 9% of cases. Normal esophagus with transition to the stomach
- Diverticula
- Oesophagus
- Stomach (Gaster)
A true diverticulum (traction diverticulum) is a protrusion of all esophageal wall layers. This shape is caused by a pull (traction) from the outside of the esophageal wall.
This form of diverticulum can occur particularly in the area where the trachea is forked (tracheal bifurcation) and the large main bronchi (branches of the trachea). They are therefore also called parabronchial diverticula (= diverticula lying next to the branches of the trachea). The causes for the development of traction diverticula are different: During embryonic development (the period of prenatal development of humans), remnants of tissue bridges between the esophagus and the trachea can remain and thus create a traction on the esophageal wall.
This means that the esophagus does not separate completely from the trachea. A scar traction, e.g. after lymphadenitis, can also lead to the development of a traction diverticulum (non-specific inflammation, tuberculosis). These scars cause the esophageal wall to be pulled outwards like a needle or funnel.
Diverticula formed in this way are usually a random finding, small and usually do not cause any discomfort. In contrast to traction diverticula, the false diverticula (emulsion or pseudodiverticula) is often associated with discomfort for the patient. Pulsion diverticula is caused by weak points in the muscle wall of the esophagus.
During the act of swallowing, the muscular contraction of the esophagus and the transport of the food causes an increase in pressure in the esophagus, as a result of which parts of the mucous membrane (mucosa and submucosa) can protrude through a gap in the muscular wall of the esophagus. It can be said that there is an imbalance between the pressure in the esophagus and the stability of the muscle wall. The Zenker’s diverticulum is one of the pulsation diverticula.
The Zenker’s diverticulum (named after the pathologist Friedrich A. von Zenker 1825-1898) is with 70% the most frequent diverticulum of the esophagus and lies shortly above the esophageal mouth (esophageal entrance in front of the stomach) in the lower back wall of the throat (hypopharynx). The Zenker’s diverticulum typical muscle weakness is also called the Kilian’s triangle. This is a regular weakness of the esophageal wall, which is why many Pulion’s diverticula develop in this area.
Another assumption is that there is a functional disorder of the upper esophageal sphincter (esophageal mouth). This dysfunction leads to an increase in pressure on the Kilian muscle gap, which leads to the formation of diverticula. In about 10% of cases, the pulmonary diverticula lie just before the passage of the esophagus through the diaphragm into the abdomen.
There they are called epiphrenal diverticula (diverticula lying above the diaphragm). This diverticulum can be caused by a strong lower esophageal sphincter (lower esophageal sphincter), which can cause food congestion and thus increase the pressure on the esophageal wall in this area. The epiphrenal diverticulum can reach a considerable size.Accordingly, complaints are also caused more frequently. In rare cases, an esophageal diverticulum may be caused by an esophageal tumor or by over-functioning of the esophageal muscles (hypercontractile esophagus).
