Diverticulum of the Esophagus *

This presentation is an attempt to summarize the available information concerning esophageal diverticulum; the pathogenesis and anatomy of its various types; its symptomatology, treatment, and particularly the complications which can occur either spontaneously or as the result of surgery. The case experience with this entity at the Grace-New Haven Hospital (University service) during the period 1942-1953 will be discussed in addition. The earliest case reported was that of Ludlow in 1764.' Zenker' in 1877 described 27 autopsied cases with their associated symptomatology and anatomical findings; the pharyngo-esophageal pulsion diverticulum is sometimes known as Zenker's diverticulum. Esophageal diverticula are classified into three groups which differ not only in anatomical location but also in pathogenesis. The first, and by far the commonest, type is the pharyngo-esophageal, located just above the junction of the hypopharynx and esophagus proper. A second or so-called traction type of diverticulum occurs in the middle portion of the esophagus in relation to the tracheal bifurcation. Finally, a very rare third type is seen in the distal esophagus just above the diaphragm. Rokitansky' in 1840 first attempted to classify esophageal diverticula according to the pathogenetic mechanism. One group, the so-called pulsion type, he considered as arising because of pressures developing within the esophageal lumen; the second, or traction type, because of forces exerted on the esophageal wall from without. This over-simplified concept has been generally accepted even to the present day.