Zayed Omar R, Chaudhuri Urmimala, Zreik Hassan, Triplett Drew J
Boonshoft School of Medicine, Wright State University, Dayton, USA.
Internal Medicine Residency Program, Wright State University, Dayton, USA.
Cureus. 2025 Aug 16;17(8):e90241. doi: 10.7759/cureus.90241. eCollection 2025 Aug.
Zenker's diverticulum is an outpouching of mucosa through Killian's dehiscence secondary to increased intraluminal pressure. It typically affects older adults, particularly males over the age of 60. Common symptoms include dysphagia, halitosis, regurgitation, and chronic cough. We present an atypical case of Zenker's diverticulum in a younger patient, who presented with shortness of breath and was found to have near-complete esophageal obstruction. A 55-year-old male with a history of hypertension presented to the emergency room with progressive shortness of breath. Gastroenterology was consulted for several months of dysphagia to both solids and liquids, accompanied by a 25 lb unintentional weight loss. He denied prior food bolus impaction. Initial evaluation included a video fluoroscopic swallow study with recommendations of a liquid diet. An esophagram revealed a large Zenker's diverticulum causing near-complete obstruction of the upper thoracic esophagus. Esophagogastroduodenoscopy (EGD) demonstrated severe upper esophageal stricture with complete obstruction and retained food material. A computed tomography (CT) scan of the soft tissue neck confirmed a large Zenker's diverticulum with significant compression of the proximal esophagus. Otolaryngology was consulted, and the patient underwent an esophagoscopy with transcervical Zenker's diverticulectomy. Postoperative esophagram showed no evidence of a leak. His diet was gradually advanced, and he was discharged in stable condition. This case highlights an uncommon presentation of Zenker's diverticulum, including complete esophageal obstruction and respiratory symptoms in a younger patient. Early identification and a multidisciplinary team were critical for successful outcomes.
Zenker憩室是黏膜通过Killian裂孔向外突出形成的，继发于管腔内压力升高。它通常影响老年人，尤其是60岁以上的男性。常见症状包括吞咽困难、口臭、反流和慢性咳嗽。我们报告了一例年轻患者的非典型Zenker憩室病例，该患者表现为呼吸急促，发现有近乎完全的食管梗阻。一名有高血压病史的55岁男性因进行性呼吸急促就诊于急诊室。因数月来固体和液体食物均吞咽困难并伴有25磅非故意体重减轻，咨询了胃肠病学专家。他否认既往有食物团块嵌塞史。初始评估包括视频透视吞咽研究，并建议采用流食饮食。食管造影显示一个大的Zenker憩室导致上胸段食管近乎完全梗阻。食管胃十二指肠镜检查（EGD）显示严重的食管上段狭窄伴完全梗阻及食物残留。颈部软组织计算机断层扫描（CT）证实有一个大的Zenker憩室，近端食管明显受压。咨询了耳鼻喉科，患者接受了食管镜检查及经颈Zenker憩室切除术。术后食管造影未显示有渗漏迹象。他的饮食逐渐恢复正常，出院时情况稳定。该病例突出了Zenker憩室一种不常见的表现形式，包括年轻患者出现完全食管梗阻和呼吸道症状。早期识别和多学科团队对于取得成功结果至关重要。
