S4292 A Rare Case of Food Impaction in Zenker’s Diverticulum Presenting With Acute Dysphagia

Introduction: Zenker’s diverticulum is a rare pharyngoesophageal outpouching through Killian’s triangle, typically presenting with halitosis, regurgitation, or cough. Dysphagia is less common. Food impaction within a Zenker’s diverticulum is an extremely rare presentation that can result in diagnostic delays and serious complications. Case Description/Methods: A 70-year-old woman with gastroesophageal reflux disease, hypertension, hypothyroidism, and known Zenker’s diverticulum presented with acute-onset dysphagia after a dinner meal. She experienced a sensation of food stuck in her throat and attempted to expel it by coughing, with partial relief. She tolerated liquids but remained unable to swallow solids overnight. Vitals were stable, physical exam showed no respiratory distress or abnormal findings. Urgent upper endoscopy revealed a Zenker’s diverticulum located just below the cricopharyngeal muscle, filled with undigested plant material and seeds. The impacted food bolus was successfully removed using a snare. A small hiatal hernia was also noted. The patient was referred to ENT for definitive evaluation and management. Discussion: Zenker’s diverticulum affects approximately 0.01%–0.11% of the population. While regurgitation and halitosis are common, food impaction is exceedingly rare. This case highlights the need to consider Zenker’s diverticulum in patients presenting with unexplained dysphagia. Complications of delayed diagnosis may include aspiration pneumonia, perforation, bleeding, or malnutrition. Prompt recognition and endoscopic management are critical. Diagnosis is often aided by endoscopy or barium swallow studies. Definitive management typically requires ENT evaluation, with treatment options ranging from conservative care to endoscopic diverticulotomy or surgical intervention. Early suspicion and intervention can prevent morbidity and optimize outcomes.