Pharyngeal pouch

In gastroenterology, a pharyngeal pouch is a pathological pulsion diverticulum of the pharyngeal mucosa through Killian's dehiscence. Killian's dehiscence (also known as Killian's triangle) is a triangular area in the wall of the pharynx between the inferior constrictor muscle and the cricopharyngeus muscle. It represents a potentially weak spot where a pharyngoesophageal diverticulum (Zenker's diverticulum) is more likely.

At first, the pouch develops posteriorly but then it protrudes to one side, usually the left. It displaces the oesophagus laterally as it enlarges.

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Incidence

Uncommon.

Risk factors

Male, old age.
Trumpet playing. Trumpeter Randy Sandke suffered this injury as a teenager, underwent surgery, took 10 years off the trumpet, and resumed playing.

Signs and symptoms

• Dysphagia (first mouthful easily swallowed but further swallowing prevented, with regurgitation of pouch contents)
• Night-time fits of coughing.
• Repeated chest infections.
• Palpable swelling in neck which may be heard to gurgle.

Investigations

• Barium swallow.
• Endoscopy should be avoided as the pouch can be easily perforated.

Management

Surgical excision of the pouch. Normal feeding delayed until complete healing of wound, which may take at least five days.

Complications

Fistula, mediastinitis, inhalation pneumonia and damage to recurrent laryngeal nerve

References

• Papadakis, Maxine A.; Tierney, Lawrence M.; McPhee, Stephen J.. Current Medical Diagnosis and Treatment 2003. McGraw-Hill/Appleton & Lange. ISBN 0071395938. 

• Mirza S, Dutt SN, Minhas SS, Irving RM (2002). "A retrospective review of pharyngeal pouch surgery in 56 patients". Annals of the Royal College of Surgeons of England 84 (4): 247-51. PMID 12215027.