A 70-year-old man comes to the physician because of several months history of difficulty swallowing pieces of meat and choking frequently during meal times. He also sometimes regurgitates foul-smelling, undigested food particles. The patient has foul-smelling breath, but his oropharyngeal and neck examinations are normal. Cardiopulmonary examination is also normal. A barium swallow shows an accumulation of contrast in an outpouching of the posterior pharyngeal wall at the C5 level. Which of the following mechanisms is the most likely cause of his symptoms?

Question

A 70-year-old man comes to the physician because of several months history of difficulty swallowing pieces of meat and choking frequently during meal times. He also sometimes regurgitates foul-smelling, undigested food particles. The patient has foul-smelling breath, but his oropharyngeal and neck examinations are normal.  Cardiopulmonary examination is also normal.  A barium swallow shows an accumulation of contrast in an outpouching of the posterior pharyngeal wall at the C5 level. Which of the following mechanisms is the most likely cause of his symptoms?

Quizplus · Accepted Answer

Eductional Objective: Diminished relaxation of cricopharyngeal muscles during swallowing results in increased intraluminal pressure in the oropharynx.  Increased intrapharyngeal pressure on a physiologically weakened area of the hypopharynx (Killian triangle) causes the local mucosa and submucosa to bulge through the muscularis propria, creating a Zenker diverticulum.

A 70-Year-Old Man Comes to the Physician Because of Several