Further evidence for Zenker’s diverticulum in a slim woman with body figure predisposition: a case report and literature review

Zenker’s diverticulum (ZD) is a bag-like pharyngeal pouch that protrudes to the outside of the pharynx. It is thought to be an acquired disease that occurs following the dysfunction of laryngopharynx muscle, and certain body shapes may be predisposed to this condition. We report a 56-year-old female of slim build with ZD. Computed tomography scanning revealed a hypodense lesion on the left posterior side of her upper esophagus that was filled with air and had no obvious wall. To verify this finding, a barium esophagogram was carried out which showed a round pouch at the level of the 6th cervical vertebral body that communicated with the esophagus through a narrow neck. ZD was subsequently confirmed by endoscopy. These findings provide further evidence in support of a body shape predisposition for ZD.

Endotracheal tube mal-insertion via Zenker’s diverticulum to trachea

An 86-year-old woman with chronic respiratory failure was under endotracheal tube insertion and mechanical ventilator support for 2 months due to previous intra-cranial hemorrhage. She presented with difficult nasogastric (NG) tube insertion after changing endotracheal tube and was transferred to our emergency room. The initial vital signs were blood pressure: 136/85 mmHg, heart rate: 100 bpm, respiratory rate: 20 cpm, body temperature: 36.5o c, and SpO2 : 100% under ventilator support, and stupor consciousness was remained as usual. The physical examination showed bilateral clear breath sound. We tried the NG tube insertion again but in vain; therefore, the esophagogastroduodenoscopy (EGD) was performed for NG tube insertion and revealed malposition of the endotracheal tube over upper esophagus and Zenker’s diverticulum with ulcerations (Panel A). Endotracheal tube was inserted to the esophagus, via the Zenker’s diverticulum, and then to the trachea. The neck CT confirmed the diagnosis (Panel B). After endotracheal tube replacement via bronchoscopy and supportive care with antibiotics treatment, the patient was discharged after admission for two weeks.