Zenker / Pharyngoesophageal diverticulum

• Mucosal outpouching through Kilian triangle.
• Pseudodiverticula.
• MC esophageal diverticula

Pathophysiology:-
• Neuromuscular incordination

C/F :-
• Dysphagia
• Age >50 years
• Halitosis
• Regurgitation

Diagnosis :-
• Barium swallow

Complications :-
• Aspiration, Lung abscess, Pneumonia

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Management :-
• Cricopharyngeal Myotomy + Diverticulopexy (T/t of choice)

Achlasia Cardia

• Destruction of nerves to LES.
• Muscles of esophagus and LES both are affected.
• Failure of LES relaxation and aperistalsis of esophageal body.

C/F :-
• Triad - Dysphagia, Regurgitation and Weight loss.
• Nocturnal coughing.

Diagnosis :-
• Barium swallow - Bird beak, Pencil tip or Rat tail sign.

• Mecholyl test - +ve
• CCK test - +ve
• Manometry - Gold std.
LES - Absent LES relaxation (<75%)
Esophageal body - Elevated intraesophageal pressure (>100 mm Hg), Simultaneous mirrored contractions

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T/t :-
• Subligual Nitroglycerine, Nitrates, CCB.
• Bougie dilation
• Botox
• Lap Heller Myotomy - Op of choice
• Toupet or Dor fundoplication

Congenital Diaphragmatic Hernia / Bockdalek Hernia

• 80% cases occur on left side.
• Failure of closure of pleuroperitoneal canal.
• Posterolateral position - Bockdalek Hernia
• Anteromedial - Morgagni Hernia

C/F :-
• Triad - Resp distress + dextrocardia + scaphoid abdomen.
• Pneumothorax on contralateral side.

Diagnosis :-
• Prentala USG
• CXR- Gastric bubble and loops of bowel within chest.

• Polyhydroaminos

T/t :-
• 24-72 hours of time to allow for stabilization is must before surgery
• Prosthetic patch
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