Endoscopic diverticulotomy for symptomatic pediatric esophageal diverticula

Congenital esophageal diverticulum - a case report and review of literature

Zenker's Diverticulum (ZD) is a false diverticulum located in the posterior esophagus between the cricopharyngeus and inferior constrictor. Few cases have been reported in the pediatric population. Congenital esophageal diverticulum is commonly associated with additional esophageal anatomical deformities or iatrogenic injury in the early post-natal period. TD was born at 39 5/7 weeks gestational age and did well at home with the exception of "choking during feeds 2-4 times per day" with mild cyanosis. Flexible bronchoscopy performed under sedation revealed a retropharyngeal mass protruding towards the epiglottis resulting in upper airway obstruction. Esophogram demonstrated upper esophageal diverticulum. Patient underwent left neck dissection with cervical myotomy from the cricopharyngeus to the level of the thoracic inlet. A postoperative repeat esophogram illustrated resolution of the diverticulum. Currently, the patient is 9 months postoperative and is tolerating feeds by mouth, gaining weight and has no pulmonary symptoms. There have been a few reports of ZD in children occurring in combination with anatomical abnormalities or esophageal manipulation. This case is one of the youngest reported and occurs in a patient without any previous manipulation of the esophagus. This condition is exceedingly rare but should be included in the differential diagnosis for both pharyngoesophageal and tracheal symptoms.