4 Zenker diverticulum A Zenker diverticulum is a false diverticulum consisting of mucosa and submucosa that arises from the posterior portion of the inferior pharyngeal constrictor muscle.
5 Anatomy of ZD The neck of the diverticulum originates between the fibers of the inferior constrictor muscle and the cricopharyngeus muscle in an area of relative weakness, Killian s dehiscence. Chang. Laryngoscope 2004;114:
6 Zenker s diverticulum True lumen
7 UES 직하방 mass 로생각함 가는내시경으로통과가능
8 Blind end pouch 옆 true lumen 발견
9 내시경삽입이어려웠던환자에서식도구멍이보임 천공의심 憩室로결론
10 증상 Transient dysphagia; early in the course Pulmonary aspiration Neck mass Food regurgitation Esophageal obstruction Recurrent aspiration pneumonia Endoscopy 2001;33:
17 Esophageal diverticulum mimicking thyroid mass Screening endoscopy: A large out-pouching lesion with food material was seen below the upper esophgeal sphincter.
18 Killian-Jamieson diverticulum (F/59) - Pseudo-thyroid lesion originating in the esophagus
19 GI & Hepatology New, Korean Edition 2010 Aug:1(3)
20 Zenker vs Killian-Jamieson Zenker's diverticulum originates on the posterior wall of the pharyngoesophageal segment in a midline area of weakness just above the cricopharyngeus (i.e., Killian's dehiscence), whereas Killian-Jamieson diverticula originate on the anterolateral wall of the proximal cervical esophagus in a gap just below the cricopharyngeus and lateral to the longitudinal tendon of the esophagus (i.e., the Killian-Jamieson space).
24 Midesophageal diverticulum with anthracotic pigmentation
25 Midesophageal diverticulum with anthracotic pigmentation 2 years later
26 Differential diagnosis of esophageal melanocytosis/melanosis Esophageal melanoma Pseudomelanosis Anthracosis, exogenous dye ingestion, hemosiderosis, lipofuscin deposition easily excluded after histologic and histochemical examination. Black esophagus Dark-pigmented esophagus with ulcerations which corresponds to severe acute inflammation with mucosal necrosis seen on histologic examination. The etiological factor involved seems to be ischemic injury caused by arteriolosclerosis, arterial thrombosis, or aortic dissection. Blue rubber bleb nevus syndrome Arch Pathol Lab Med 2006;130:
27 Anthrocosis in diverticulum Pathology International 2002;52:
28 Anthrocosis in diverticulum Pathology International 2002;52:
29 Anthrocosis in diverticulum Pathology International 2002;52:
30 M/80 chronic dysphagia 7YA. Dysphagia (+). Heartburn/chest pain(-/-) 3YA. Esophageal diverticulum was diagnosed but no treatment.
31 EGD at SMC
34 Endoscopic septal dissection
36 Diverticular septal dissection (Video)
37 Final image after the procedure
38 Epiphrenic esophageal diverticulum Out-pouching of the distal esophageal lumen Typically originating from 4-8cm above the cardia Prevalence: 0.015% based on radiologic data < 10% of all esophageal diverticula
65 Sigmoid colon cancer - mimicking acute diverticulitis
68 게실질환 게실출혈 Most common cause of massive hematochezia (30-50% of cases) 15% of patients with diverticulosis will bleed 75% of diverticular bleeding stops without intervention Risk of rebleeding 14-38% After second episode of bleeding, risk of rebleeding 21-50% 삼성서울병원내과김태준교수님제공
69 게실출혈 내시경적지혈술 게실입구가넓어서게실바닥의혈관을바로 target 하여 clipping 한경우 삼성서울병원내과김태준교수님제공
72 Symptomatic uncomplicated diverticular disease (SUDD) Persistent abdominal symptoms attributed to diverticula Absence of macroscopically overt colitis or diverticulitis Wall thickening in the absence of inflammatory changes on CT Colicky Constant or intermittent Relived by passing flatus Having a bowel movement Symptoms may resemble irritable bowel syndrome (IBS)
73 Segmental colitis associated with diverticula (SCAD) Inflammation in the inter-diverticular mucosa without involvement of the diverticular orifices. Prevalence ranges from 0.26 to 1.5 percent who had underwent colonoscopy with symptoms. Pathogenesis is unclear Chronic diarrhea Cramping abdominal pain primarily in the LLQ Intermittent hematochezia, in some cases