Pharyngoesophageal Diverticulum

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THE objective of treatment of esophageal diverticulum is to relieve the dysphagia and regurgitation with the least risk of mediastinitis, infection of the wound, recurrence of the diverticulum, or injury to laryngeal and sympathetic nerves. Since excision, inversion, or elevation of the diverticulum all relieve the major symptoms, the selection of the type of operation depends upon its safety and prevention of recurrence. We have studied records of a small series of patients treated either by excision or by inversion to determine which of these two methods is the safer and more reliable.

Pathogenesis and Symptoms

Pharyngoesophageal diverticulum is a pouchlike herniation of the pharyngeal mucosa and submucosa through a weak region in the musculature of the distal hypopharynx. This rare condition occurs predominantly in men during the fifth to the seventh decades of life. Its pathogenesis was well understood and described by Stetten1 and by Jackson and Shallow2 in the early part of this century. The predisposing factors are: (1) a structural weakness of the tissues that are located between the oblique fibers of the posterior portion of the inferior constrictor muscle and the transverse fibers of the cricopharyngeus (Fig. 1); (2) a degenerative relaxation of the elastic tissue of the hypopharyngeal wall; this relaxation is said to be aggravated by pressure against the cervical vertebrae;3 and (3) an in-co-ordination of the function of the cricopharyngeus.4

The cricopharyngeus is a sphincteric muscle, which Jackson and Shallow2 called a “pinchcock,” for it occludes the upper esophagus during respiration. During normal. . .



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