A Case of Papillary Thyroid Carcinoma Accompanied by Zenker’s Diverticulum: Considerations for Surgery

이동우,이형신 대한갑상선학회 2022 International Journal of Thyroidology Vol.15 No.2

Zenker’s diverticulum is rarely known to be an impediment to the diagnosis and surgical procedure for thyroid disease. In this report, we discuss a rare case of pre-operative diagnosis of asymptomatic Zenker’s diverticulum and surgical treatment of the disease during thyroidectomy. A 48-year-old male was referred to our hospital with multiple thyroid nodules confirmed to be papillary thyroid cancer. Pre-operative ultrasonography and computed tomography scan findings suggested the presence of a left Zenker’s diverticulum. The left pharyngeal pouch was treated by reinforcing the overlying soft tissue during thyroidectomy, without structural injury to the recurrent laryngeal nerve. We report this case with a focus on the considerations during the pre-operative diagnosis and precautions to be taken during surgery, such as the distorted path of the recurrent laryngeal nerve and manipulation of the diverticulum.

우측 갑상선결절로 오인된 젠커게실 1례

최창원 ( Chang Won Choi ),안화영 ( Hwa Young Ahn ) 대한갑상선학회 2018 International Journal of Thyroidology Vol.11 No.1

Zenker’s diverticulum, a pulsion diverticulum of the hypopharynx, is a rare lesion that commonly occurs in left side of hypopharynx. The incidence of esophageal diverticula is much lower than that of focal lesions or nodules of thyroid. In an ultrasonography, the outpouching just like a focal thyroid lesion, may present as an oval or circular structure. The food remnants or gas bubbles present in the diverticulum may mimic microcalcifications presented in papillary thyroid carcinoma. We reported a case of right side Zenker’s diverticulum mimicking a thyroid cancer in thyroid ultrasonography.

Acquired Pharyngeal Diverticulum after Anterior Cervical Fusion Operation Misdiagnosed as Typical Zenker Diverticulum

박종명,김창완,김도형 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.4

A pharyngeal diverticulum is a rare complication of an anterior cervical discectomy and fusion (ACDF). We present a c ase of a p haryngeal d iverticulum after an A CDF, w hich was m isdiagnosed as a typical Z enker diverticulum. A 54-year-old woman presented with dysphagia and a sense of irritation in the neck following C5 through C7 cervical fusion 3 years prior. The patient underwent open surgery to resect the diverticulum with concurrent cricopharyngeal myotomy. An ACDF-related diverticulum is difficult to distinguish from a typical Zenker diverticulum.

성대마비를 동반한 갑상선 종양으로 오인된 Zenker게실 치험 1예

이종대,박훈,신재민,고윤우 대한이비인후과학회 2006 대한이비인후과학회지 두경부외과학 Vol.49 No.2

We usually consider the anterior neck mass associated with ipsilateral vocal cord paralysis as a thyroid tumor. Zenkers diverticulum (ZD) is classically defined as a pulsion diverticulum between the cricopharyngeal muscle and inferior constrictor muscle in an area of Killian's triangle. If ZD increases sufficiently, it might be presented as a anterior neck mass, or a thyroid tumor. In the literature, ZD has been rarely presented as a thyroid mass associated with ipsilateral vocal cord palalysis. ZD occurs predominantly in the elderly and induces non-specific symptoms such as dysphagia, regurgitaion, aspiration pneumonia, and halitosis. Vocal cord paralysis associated with ZD may be related to carcinoma occurring in ZD. We report, with a brief review of literature, a case of ZD mimicking the thyroid tumor associated with vocal cord paralysis and treated with surgery.. (Korean J Otolaryngol 2006;49:241-5)

윤상인두 연하장애와 젠커 게실의 치료

권택균,이원용 대한연하장애학회 2012 대한연하장애학회지 Vol.2 No.2

Cricopharyngeal dysphagia is a common condition of the dysphagic patients. For adequate diagnosis and treatment of the disease, it is needed to understand the complex anatomy and physiology and phathophysiology of the cricopharyngeal muscle. A variety of methods are used for the diagonosis of the cricopharyngeal dysphagia. There are nonsurgical treatment and surgical treatment to resolve the cricopharyngeal dysphagia. We explain several procedures that resolve the disease. And Zenker’s diverticulum is the most common diverticulum in the upper gastrointestinal tract. Most patients are present with dysphagia. The treatments are open surgical diverticulectomy with or without cricopharyngeal myotomy and rigid endoscopic myotomy. We describe the management of Zenker’s diverticulum.. (JKDS 2012;2:46-52)

경성 경구강 내시경을 이용한 게실 절개술 후 재발로 개방 게실 절제술을 시행한 젠커게실 1예

이영정,박기남,이정현,정준영 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.12

The traditional approach to diagnosis and management of Zenker’s diverticulum is open surgicaltreatment. More recently, however, endoscopic technique is also frequently used for Zenker’sdiverticulum because it has advantages of shortening operation time, postoperativehospitalization and reducing the complication such as recurrent laryngeal nerve injury. A75-year-old male, who was diagnosed with Zenker’s diverticulum, underwent a secondaryopen diverticulectomy after failed attempt at rigid transoral endoscopic diverticulotomy. Herewe report this case with a review of literature.

Endoscopic management of Zenker’s diverticulum

Zaheer Nabi,Duvuur Nageshwar Reddy 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.2

Zenker’s diverticulum (ZD) is a rare condition that predominantly effects elderly population. Dysphagia and regurgitation are the common presenting symptoms in patients with ZD. Flexible endoscopic diverticulotomy (FED) of the cricopharyngeal septum is the mainstay of management in symptomatic ZD. The outcomes of FED compare favorably to open surgical and trans-oral rigid endoscopic treatment methods. Moreover, FED is associated with relatively fewer morbidities as compared to surgery. Bleeding and micro-perforation are the most commonly reported immediate adverse events. Majority of the adverse events are mild and severe adverse events are rare with FED. Recurrence of symptoms remain the most important long-term concern after FED. Nevertheless, majority of the recurrences respond to a repeat session of endoscopic treatment. Lately, new electrosurgical knives and novel endoscopic techniques of cricopharyngeal myotomy have been evaluated for the treatment of ZD. Novel techniques include double incision with snare resection and submucosal tunneling endoscopic septum division. The proposed advantage with these techniques is possible reduced incidence of recurrences after endoscopic treatment. Randomized comparison studies are required between new and conventional flexible endoscopic techniques. In addition, standardized reporting of clinical success, and adverse events is required in future studies.

Endoscopic management of Zenker’s diverticulum

Zaheer Nabi,Duvuur Nageshwar Reddy 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.2

Zenker’s diverticulum (ZD) is a rare condition that predominantly effects elderly population. Dysphagia and regurgitation are the common presenting symptoms in patients with ZD. Flexible endoscopic diverticulotomy (FED) of the cricopharyngeal septum is the mainstay of management in symptomatic ZD. The outcomes of FED compare favorably to open surgical and trans-oral rigid endoscopic treatment methods. Moreover, FED is associated with relatively fewer morbidities as compared to surgery. Bleeding and micro-perforation are the most commonly reported immediate adverse events. Majority of the adverse events are mild and severe adverse events are rare with FED. Recurrence of symptoms remain the most important long-term concern after FED. Nevertheless, majority of the recurrences respond to a repeat session of endoscopic treatment. Lately, new electrosurgical knives and novel endoscopic techniques of cricopharyngeal myotomy have been evaluated for the treatment of ZD. Novel techniques include double incision with snare resection and submucosal tunneling endoscopic septum division. The proposed advantage with these techniques is possible reduced incidence of recurrences after endoscopic treatment. Randomized comparison studies are required between new and conventional flexible endoscopic techniques. In addition, standardized reporting of clinical success, and adverse events is required in future studies.

자동위장문합기(GIA : Gastrointestinal Autostapler)를 이용한 젠커게실 치험 1예

이준엽,김동은,여창기 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.3

Zenker diverticulum is rare and symptoms of diverticulum are atypical. This is most commonly seen at the Killian’s triangle. This is caused by altered motility, which results in abnormal intraluminal pressure and the pushing of the mucosa through weakness of the wall. Treatment is surgical via an endoscopic or external approach. Previous external approaches are associated with high com-plication rates and morbidity. We report a new external surgical approach using the gastrointestinal autostapler (GIA) instrument. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:292-5)

Zenker 게실 환자에서 내시경적 접근법을 통해 Energy Device를 이용한 게실절개술 1예

김현범,임연희,안희선,박영학 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.4

Zenker’s diverticulum (ZD) is an abnormally protruding space in the Killian triangle due toweakness between the inferior pharyngeal constrictor muscle and cricopharyngeal muscle. Arare disease that is found more often in the West than in the East, it occurs in the elderly, inducingdysphagia, globus symptom, reflux and etc. For the treatment, various transoral endoscopictechniques have been developed over the past 20 years: these include flexible and rigidendoscopy are used and several devices like scissors, staplers, CO2 laser and energy device. We report here the first case using the endoscopic energy device assisted diverticulostomy ofZD in Korea. Transoral endoscopic treatment is less invasive than classical transcervical approachtreatment, showing better clinical course and results. Both rigid endoscope and energydevice are also very familiar to head and neck surgeons, so this approach can be one of thebest treatments for ZD.