PHARYNGEAL POUCH

By Monzur Ahmed

Pharyngeal pouches (diverticula) are a common cause of dysphagia; they are associated with various morbidities and a decreased quality of life. There are several types of diverticula which are classified according to the anatomical location of their origin relative to the cricopharyngeal muscle. These include Zenker's, Killian-Jamieson's, and Laimer's diverticula. By far the most common is Zenker's diverticula, characterised by a posterior outpouching originating from Killian's dehiscence of the inferior constrictor muscle, between the cricopharyngeal and thyropharyngeal muscles. The Killian-Jamieson diverticulum is much rarer and is a herniation through the anterolateral located superolateral to the longitudinal muscle of oesophagus and inferior to the cricopharyngeal muscle. The rarest variant of pharyngeal diverticulum is often referred to as Laimer's or Laimer-Haeckerman's diverticulum. Similar to the Killian-Jamieson diverticulum, it originates between cricopharyngeus and the longitudinal muscle of the oesophagus; however, it is located posteriorly and midline, from the area termed Laimer-Haeckerman's triangle, and is covered only by the circular muscles of the oesophagus. Pharyngeal pouches can make endoscopic intubation difficult and even hazardous, with a risk of perforation. Hence, if a pouch is suspected or proven, then it is important to appreciate the anatomy of the pharyngeo-oesophageal region in order to safely intubate the oesophagus. The video shows a recent case of an elderly co-morbid patient where previous attempts at intubation were unsuccessful (see video)…