OBJECTIVE: Zenker's diverticulum is a herniation of the mucous membrane of the hypopharynx through its posterior wall, and presents with dysphagia as its main clinical manifestation. This paper presents a case of Zenker's diverticulum treated by the open trans-cervical approach. CASE REPORT: A 68-year-old woman complaining of dysphagia, regurgitation of food, and a sensation of having a lump stuck in the neck was referred to our service with a diagnosis of Zenker's diverticulum. She had undergone surgical repair of hiatal hernia 12 years ago. Palpation of the neck revealed no mass, enlarged lymph nodes, or crepitus. Barium swallow showed a saccular mass projecting off the posterior esophagus wall, corresponding to a Zenker's diverticulum; the diagnosis was confirmed by a CT scan and endoscopy. The patient underwent diverticulectomy with cricopharyngeal myotomy through an open cervical approach under general anesthesia. She was hospitalized for 13 days, because she and her family found it difficult to handle the nasogastric tube used for enteral nutrition. The only post-operative complication was diarrhea that was corrected by adjusting her enteral feeds. Histopathological examination confirmed pharyngoesophageal diverticulum with chronic inflammation and severe mucosal erosion. The patient improved satisfactorily, and another endoscopy done 6 months after the procedure did not reveal either any complication or any evidence of recurrence. CONCLUSION: Zenker's diverticulum is not common, but should still be considered in the differential diagnosis of dysphagia. Imaging tests help in diagnosing the condition after the condition is suspected clinically. The open approach continues to be a valid management option with low rates of complications and recurrences, despite the development of endoscopic techniques.
