A reader asks: “What’s a Zenker’s diverticulum?”
The term “diverticulum” comes from the Latin “diverticulare,” which means “to turn aside.” A more visual understanding of a diverticulum would be to imagine an old automobile tire wearing out at the sidewalls. Older folks will remember seeing tires with the inner tubes bulging through the sidewalls of worn tires. A diverticulum is the pouch that results when one of our “inner tubes” bulges out through the weakened walls of any of our hollow or fluid filled body structures.
First described in 1767, a Zenker’s diverticulum is a rare (2/100,000) pouch created by the bulging of the esophagus (food tube) through a weak area in the backside of the muscular wall. Zenker’s diverticulum occurs in the higher part of the esophagus, and in the highest part, it’s called a Killian–Jamieson diverticulum. If the pouch develops in the middle part, it’s called a traction diverticulum, and if in the lower part, it’s an epiphrenic diverticulum. (Big name pouches!)
Symptoms of Zenker’s diverticulum are usually related to swallowing difficulty, and might include bad breath, choking, unusual noises, or food actually coming back into the mouth. Diagnosis is usually by swallowing liquid barium while a radiologist watches live using fluoroscopy. Zenker’s diverticula can rupture, leading to serious infection and other complications, and rarely, cancer can occur in the pouch. Treatment is surgical.
Of course, our bodies have other “inner tubes,” and most people have known someone who had “diverticulitis,” a painful inflammation of the colon. Diverticulitis begins in diverticula of the colonic walls. These small outpouchings of the colon frequently trap poorly digested food items like seeds and popcorn kernels. This trapped debris causes inflammation, which in turn leads to painful abdominal cramping, can cause fever and blood and mucus in the stool. If the pouch of colon actually ruptures, life-threatening abdominal infection can occur. First line treatment of mild diverticulitis is the use of oral antibiotics. More serious infections require hospitalization and intravenous antibiotics. Some people have so many diverticula and frequent bouts of diverticulitis that they require surgical removal of the involved section of the colon.
Diverticula can occur in the small bowel, and Meckel’s diverticulum is a hereditary solitary pouch present from birth towards the end of the small bowel. Complications from a Meckel’s diverticulum only occur in about 2 percent of people with the finding.
Other sites for diverticula in other “inner tubes” include the ureter (tube from kidney to bladder), bladder, urethra (tube that carries urine from the bladder), and basically any of the hollow or fluid filled structures of the body.
Some diverticula never cause problems, and many of us have no idea that we have them. If you are concerned, especially with trouble swallowing, fevers, problems urinating, or severe abdominal cramping, please consult your primary care physician for further evaluation.
Keep the questions coming!
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr, Fleming at AskDrFleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).