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A pharyngeal pouch is a pocket that can form in the mucous coat of the pharynx, the back of the throat between the mouth and esophagus. It is sometimes called Zenker's diverticulum after a German pathologist named Friedrich Albert von Zenker. Zenker suggested in 1877 that the pharyngeal pouch was probably caused by high pressures in the lower pharynx at a weak spot in the mucous coat. The condition occurs most often in elderly patients, but can occur at any age. In rare cases, the condition can result in a carcinoma, or cancerous tumor, in the pharynx, so long-term follow-up appointments often are ordered, especially in younger patients.
When a person develops a pharyngeal pouch, some of the food that is eaten falls into the pouch when swallowing. Once the pouch is filled up, it extends out into the esophagus. This can make it difficult for food to pass through the esophagus to the stomach. The pouch can increase the risk of choking because food caught in it can fall out, causing a person to choke or spit up food that was eaten hours before. This can especially be a danger at night, because the position of lying down makes it easier for collected food to fall out. Swallowing medicine also can be problematic because pills can get trapped in the pouch, where they're unable to be absorbed by the stomach.
Someone with a pharyngeal pouch may have difficulty swallowing, make gurgling noises in the throat, and, on rare occasions, exhibit a lump on the neck. The condition most commonly affects Caucasian men over the age of 50. A person may exhibit symptoms for an extended period of time before being diagnosed with a pharyngeal pouch because of the subtle nature of the condition.
A videofluoroscopy swallow study, or barium swallow, is the most effective way of diagnosing a pharyngeal pouch. The test consists of drinking a solution that contains barium sulfate, a metallic compound that is visible on x-rays. The videofluoroscopy test uses a video x-ray to track the path of the barium sulfate through the digestive system, revealing any discrepancies that might exist. The compound usually doesn't leave any lasting symptoms, but drinking plenty of fluids and eating raw fruits and vegetables is usually advised to help flush the barium sulfate out of the body.
Treatment for a pharyngeal pouch is not usually required if no significant symptoms or complications exist, but surgery may become necessary if any aspirations, ulcerations, or carcinomas are detected. The pouch can be treated with either an endoscopic method or open surgery. The endoscopic approach consists of sliding an esophagoscope down the throat and using either staples or a laser to seal the pouch. With open surgery, an incision is made in the neck and the pharyngeal pouch is cut loose and removed from the surrounding tissues.
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