Mansoor Zafar
A 71 years of age male assessed in the Emergency Department for worsening dysphagia. On further inquiry he gave history of weight loss, regurgitation, halitosis, cough, aspiration pneumonia, and neck pain. He had remote history of Endoscopic stapling eight years ago for Zenker’s diverticulum. He underwent Upper Gastrointestinal Endoscopy, and Magnetic Resonance Imaging of Cervical Spine that suggested upper pouch and suggestion for Barium swallow for further characterization. The Barium swallow demonstrated the Zenker’s diverticulum posterior to oesophagus, between C6, C7 cervical spine level. Patient was managed with Total Parenteral Nutrition via Peripherally inserted Central Catheter (PICC) line, with regular refeeding bloods, chest physiotherapy and antibiotics that resulted in weight gain. Patient consented for Endoscopic Stapling with Otorhinolaryngology (ENT) Surgeons, with improvement of his symptoms. Learning Points: 1. Progressively worsening dysphagia is an important clue. 2. Regurgitation of food eaten 1 to even 5 days ago is important clue in the history taking, towards narrowing down to Zenker’s diverticulum. 3. Differentiation between Dysphagia and Regurgitation of food is important differential to consider towards possible diagnosis. 4. Importance of Barium swallow imaging, in better characterization of organic cause. 5. Zenker’s diverticulum can recur following treatment.
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