A perforated Zenker's diverticulum and a difficult airway: A case report

Zenker's diverticulum (ZD) is a rare condition characterized by herniation of hypopharyngeal mucosa, creating a pouch that accumulates food debris and secretions. Patients typically present with dysphagia and increased aspiration risk, posing significant challenges for anesthetic management due to anatomical distortion and physiological compromise. We report a patient with ZD who experienced iatrogenic esophageal perforation leading to mediastinitis and pleural effusion following endoscopic diverticulectomy, necessitating urgent video-assisted thoracoscopic surgery (VATS). The airway was managed using video laryngoscopy for tracheal intubation and an EZ-bronchial blocker® to achieve one-lung ventilation. Anesthesiologists should recognize both anatomically and physiologically difficult airways presented by patients with perforated ZD. Anesthesia management of these patients requires special considerations due to the possibility of adverse perioperative intubation events resulting from physiological derangements. Meticulous planning, including first-pass intubation with video laryngoscopy and effective lung isolation with a bronchial blocker, is crucial for successful anesthetic management.