Location of Zenker's Diverticulum
Zenker's diverticulum is located at the pharyngoesophageal junction, specifically in the posterior pharyngeal wall through Killian's dehiscence (also called Killian's triangle), which is the anatomical space between the inferior pharyngeal constrictor muscle and the cricopharyngeus muscle. 1, 2, 3
Anatomical Details
The diverticulum occurs dorsally (posteriorly) at the pharyngoesophageal junction, representing the transition point between the pharynx and the upper esophagus 1, 2, 3
It is NOT located within the esophagus itself, but rather at the junction just above where the true esophagus begins 3, 4
Killian's dehiscence is the specific anatomical weak point where the mucosa and submucosa herniate through to form this pulsion pseudodiverticulum 2, 3
Clinical Significance of Location
The location immediately adjacent to the cricopharyngeal muscle explains why myotomy of this muscle is the cornerstone of treatment 1, 2, 4
Biphasic esophagram is the preferred imaging modality and will demonstrate the diverticulum arising from the posterior pharyngeal wall at the pharyngoesophageal junction 5
The posterior location makes it accessible to both rigid and flexible endoscopic approaches, as the septum between the esophageal lumen and diverticulum can be divided transorally 4
Important Caveat
When evaluating dysphagia with suspected Zenker's diverticulum, the entire esophagus and gastric cardia should be carefully examined, as patients may have referred dysphagia from lesions elsewhere, and the diverticulum may be incidental rather than the cause of symptoms 5, 6