GASLESS ABDOMEN 6.2 PHARYNGEAL/OESOPHAGEAL POUCHES AND DIVERTICULA 6.3 Dr. Fiza Islam Resident CMH Diagnostic Radiology 1

GASLESS ABDOMEN Adult 1. Ascites. 2. Pancreatitis (acute) – due to excess vomiting. 3. Fluid-filled bowel – closed-loop obstruction, total active colitis, mesenteric infarction (early), bowel washout. 4. High obstruction – e.g. gastric outflow obstruction, congenital atresia. 5. Large abdominal mass – pushes bowel laterally. 6. Normal. 2

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PHARYNGEAL/OESOPHAGEAL POUCHES AND DIVERTICULA Upper third 1. Zenker’s diverticulum – posteriorly, usually on left side, between the fibres of the inferior constrictor and cricopharyngeus. Can cause dysphagia, regurgitation, aspiration and hoarseness ± an air–fluid level. 5

PHARYNGEAL/OESOPHAGEAL POUCHES AND DIVERTICULA Upper third 2. Lateral pharyngeal pouch and diverticulum – through the unsupported thyrohyoid membrane in the anterolateral wall of the upper hypopharynx. Pouches are common and patients are usually asymptomatic. Diverticula are uncommon and are seen in patients with chronically elevated intrapharyngeal pressure, e.g. glassblowers and trumpeters. 6

PHARYNGEAL/OESOPHAGEAL POUCHES AND DIVERTICULA Upper third 3. Lateral cervical oesophageal pouch and diverticulum – through the Killian–Jamieson space. Pouches are transient; diverticula are persistent. Patients are usually asymptomatic. The opening is below the level of cricopharyngeus 7

PHARYNGEAL/OESOPHAGEAL POUCHES AND DIVERTICULA Middle third 1. Traction – at level of carina. May be related to fibrosis after treatment for TB. Asymptomatic. 2. Developmental – failure to complete closure of tracheooesophageal communication. 3. Intramural – rare. Multiple, tiny flask- shaped outpouchings. 90% have associated strictures, mainly in the upper third of the oesophagus. 8

PHARYNGEAL/OESOPHAGEAL POUCHES AND DIVERTICULA Lower third 1. Epiphrenic. 2. Ulcer – peptic or related to steroids/immunosuppression and radiotherapy. 3. Mucosal tears – Mallory–Weiss syndrome, postoesophagoscopy. 4. After Heller’s operation. 9

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