Surgery for Killian-Jamieson diverticulum: a report of two cases

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Abstract

Background

Killian-Jamieson diverticulum (KJD) is a rare diverticulum arising from a muscular gap in the anterolateral wall of the proximal cervical esophagus. The first choice of treatment for KJD remains controversial due to its rare incidence. Here, we report two cases of KJD for which we performed different surgery: diverticulectomy in one case and diverticulopexy in the other.

Case presentation

Case 1 involved a 58-year-old woman presenting progressive pharyngeal discomfort for the past year. She was diagnosed as KJD using endoscopic and radiographic findings. She underwent diverticulectomy with cricopharyngeal and proximal esophageal myotomy. Staple line leakage developed at 1 month after surgery and was successfully treated conservatively. At 5 months after surgery, she was asymptomatic. Case 2 involved a 77-year-old woman presenting dysphagia for the past 2 years. She had a history of bilateral breast cancer and had hypertension, asthma, and osteoporosis. Taking her age and medical history into account, we selected diverticulopexy with cricopharyngeal and proximal esophageal myotomy. The postoperative course was uneventful. At 2 years after surgery, she remained free of dysphagia.

Conclusion

The first choice of surgery for KJD is diverticulectomy. In a high-risk patient, diverticulopexy is a reasonable treatment. We recommend the addition of myotomy as a part of any surgical treatment.

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Most cited references 33

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Pharyngeal (Zenker's) diverticulum is a disorder of upper esophageal sphincter opening.

Ian J Cook, Mary Gabb, Voula Panagopoulos … (1992)

Pharyngeal coordination, sphincter opening, and flow pressures during swallowing were investigated in patients with pharyngeal (Zenker's) diverticula. Fourteen patients with diverticula and 9 healthy age-matched controls were studied using simultaneous videoradiography and manometry. Pharyngeal and upper esophageal sphincter pressures were recorded by a perfused side hole/sleeve assembly. Temporal relationships among swallowing events, extent of sphincter opening during swallowing, and intrabolus pressure during bolus passage across the sphincter were measured. The timing among pharyngeal contraction and sphincter relaxation, opening, and closure did not differ between patients and controls. Sphincter opening was significantly reduced in patients compared with controls in sagittal (P = 0.0003) and transverse (P = 0.005) planes. Manometric sphincter relaxation was normal in patients. Intrabolus pressure was significantly greater in patients than in controls (P = 0.001). It is concluded that Zenker's diverticulum is a disorder of diminished upper esophageal sphincter opening that is not caused by pharyngosphincteric incoordination or failed sphincter relaxation. Incomplete sphincter opening is likely to cause dysphagia. Increased hypopharyngeal pressures during swallowing are probably important in the pathogenesis of the diverticulum.

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Modern pathophysiology and treatment of esophageal diverticula.

Fernando A M Herbella, Marco G Patti (2012)

Esophageal diverticula are rare. They may occur in the pharyngoesophageal area (Zenker's), midesophagus, or distally (epiphrenic). A motility disorder (either at the level of the esophageal sphincters or body) is frequently associated with esophageal diverticula. The risk of malignant transformation is low. A literature search was performed using Medline/PubMed database. The treatment of esophageal diverticula must be based on the pathophysiology and natural history of the disease: (a) asymptomatic diverticula do not need a specific treatment, (b) small diverticula may be left in place and not resected, (c) medium-size diverticula may be either treated by diverticulectomy, diverticulopexy, or esophagodiverticulostomy in case of pharyngoesophageal diverticula, (d) resection is probably the ideal therapy for larger diverticula, and (e) a myotomy should always be included to the procedure. Due to its rarity, esophageal diverticula must be treated by esophageal surgeons since even in experienced hands the complication rate can be significant.

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Killian-Jamieson diverticula: radiographic findings in 16 patients.

S E Rubesin, Steven LeVine (2001)

The purpose of this study was to reassess the findings of Killian-Jamieson diverticula (i.e., proximal lateral cervical diverticula) on pharyngoesophagograms and to compare the prevalence, clinical findings, and radiographic findings of Killian-Jamieson diverticula with those of Zenker's diverticulum. A computerized search of radiology files revealed 16 patients with Killian-Jamieson diverticula and 26 patients with a Zenker's diverticulum. The double-contrast pharyngoesophagograms and medical records were reviewed retrospectively. Only three (19%) of 16 patients with Killian-Jamieson diverticula had symptoms attributable to the diverticula (suprasternal dysphagia in two and cough in one), and none had aspiration pneumonia. In contrast, 16 (62%) of 26 patients with a Zenker's diverticulum had suprasternal dysphagia and three patients (12%) had aspiration pneumonia. Twenty Killian-Jamieson diverticula were detected on pharyngoesophagograms in 16 patients, including 12 (75%) with unilateral left-sided diverticula and four (25%) with bilateral diverticula. The Killian-Jamieson diverticula had an average maximal dimension of 1.4 cm. Zenker's diverticulum was nearly four times as common as Killian-Jamieson diverticula and had an average maximal dimension of 2.5 cm. Three patients (11%) with a Zenker's diverticulum had reflux of barium from the diverticula into the hypopharynx with overflow aspiration. Finally, gastroesophageal reflux was detected in nearly twice as many patients with a Zenker's diverticulum as with Killian-Jamieson diverticula. Killian-Jamieson diverticula are less common and smaller than Zenker's diverticulum. Killian-Jamieson diverticula are less likely to cause symptoms and are less likely to be associated with overflow aspiration or gastroesophageal reflux than is Zenker's diverticulum.

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Author and article information

Contributors

Kohei Saisho: saisho_kouhei@med.kurume-u.ac.jp

Satoru Matono: ms0805@med.kurume-u.ac.jp

Toshiaki Tanaka: totanaka@med.kurume-u.ac.jp

Naoki Mori: mori1118@med.kurume-u.ac.jp

Haruhiro Hino: h_hino@med.kurume-u.ac.jp

Masahiro Fujisaki: fujisaki_masahiro@med.kurume-u.ac.jp

Masashi Nakagawa: nakagawa_masashi@med.kurume-u.ac.jp

Fumihiko Fujita: ffujita@med.kurume-u.ac.jp

Yoshito Akagi: yoshisg@med.kurume-u.ac.jp

Journal

Journal ID (nlm-ta): Surg Case Rep

Journal ID (iso-abbrev): Surg Case Rep

Title: Surgical Case Reports

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Electronic): 2198-7793

Publication date (Electronic): 13 January 2020

Publication date PMC-release: 13 January 2020

Publication date Collection: December 2020

Volume: 6

Electronic Location Identifier: 17

Affiliations

ISNI 0000 0001 0706 0776, GRID grid.410781.b, Department of Surgery, , Kurume University School of Medicine, ; 67, Asahimachi, Kurume City, Fukuoka Prefecture 830-0011 Japan

Article

Publisher ID: 789

DOI: 10.1186/s40792-020-0789-0

PMC ID: 6957605

PubMed ID: 31933008

SO-VID: 14ee7a66-6785-4f2f-abd6-f8d7f15f22dd

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 9 October 2019

Date accepted : 6 January 2020

Custom metadata

Keywords: killian-jamieson diverticulum,pharyngoesophageal diverticulum,diverticulectomy,diverticulopexy

Data availability:

Keywords: killian-jamieson diverticulum, pharyngoesophageal diverticulum, diverticulectomy, diverticulopexy

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Surgery for Killian-Jamieson diverticulum: a report of two cases

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Abstract

Background

Case presentation

Conclusion

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 33

Pharyngeal (Zenker's) diverticulum is a disorder of upper esophageal sphincter opening.

Modern pathophysiology and treatment of esophageal diverticula.

Killian-Jamieson diverticula: radiographic findings in 16 patients.

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