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Dysphagia, regurgitation and weight loss in an elderly man

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An 84-year-old man reported unintentional weight loss of 15 kg over 18 months and dysphagia and regurgitation of undigested food over 3 months. Barium swallow showed a large pharyngo-oesophageal (Zenker) diverticulum. These are caused by elevated intraluminal pressure at the Killian dehiscence, an area of hypopharyngeal weakness between the cricopharyngeus and inferior pharyngeal constrictors.

Zenker diverticuli are rare, but can cause significant morbidity and mortality. A barium swallow should precede gastroscopy, as there is a risk of perforation and mediastinitis. We performed endoscopic stapling, as it is less invasive than open repair.