Pharyngeal pouch.html



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In gastroenterology, a pharyngeal pouch is an uncommon pathological outpouching of the pharyngeal mucosa through a weak area of the pharyngeal wall (Killian's dehiscence).

Initially the pouch develops in a posterior location, but can progress to a lateral (to one side) protrusion (usually to the left) as it enlarges. The pouch may displace the oesophagus laterally (to one side) as it enlarges.

Risk Factors

• Male sex
• Advancing age
  

Signs and Symptoms

• Dysphagia : the first mouthful of food is typically swallowed easily, but further swallows may be impaired.
• Regurgitation : of pharyngeal pouch contents
• Coughing, especially at night: this is due to irritation of the cough receptors in the wind-pipe by accidental undigested food inhalation
• Recurrent chest infection
• Lump in the neck : may be felt or visible
• Audible gurgle during swallow (through use of a stethoscope or normal hearing)

Investigations

• Barium swallow: if pharyngeal pouch is present, this will show up as a large reservoir of barium contrast, external to (but communicating with) the oesophagus
• Endoscopy should be avoided as the pouch can be easily perforated

Management

Surgical excision of the pouch. Normal feeding delayed until complete healing of wound, which may take at least five days.

Complications

• Fistula formation: long-term inflammation of the pouch and oesophagus may give rise to a small tube (tract), connecting with an adjacent structure (for example, the trachea)
• Mediastinitis
• Inhalation pneumonia
• Recurrent laryngeal nerve damage; leading to loss of voice

Notable Examples

• Randy Sandke : a notable trumpeter

References

• Papadakis, Maxine A.; Tierney, Lawrence M.; McPhee, Stephen J.. Current Medical Diagnosis and Treatment 2003. McGraw-Hill/Appleton & Lange. ISBN 0071395938. 

• Mirza S, Dutt SN, Minhas SS, Irving RM (2002). "A retrospective review of pharyngeal pouch surgery in 56 patients". Annals of the Royal College of Surgeons of England 84 (4): 247–51. PMID 12215027.