Clinical features

The clinical features of a pharyngeal pouch include:

• more often in men - usually, in the elderly
• history of dysphagia which is characteristic: the first mouthful is swallowed easily but the pouch rapidly becomes filled with food and obstructs the upper oesophagus. Further swallowing is prevented and the contents of the pouch are regurgitated.
• palpable swelling in the neck in two-thirds of cases which may gurgle
• fits of coughing and episodes of pulmonary infection, especially at night, due to the inhalation of regurgitated food

The diagnosis is confirmed by barium swallow. A barium-filled sac is demarcated lying posteriorly and usually to the left of the oesophagus. It may be compressed if the pouch is large. Unlike an oesophageal web, barium is seen to overflow from the top of the pouch.

Endoscopy does not add further diagnostic information and may be dangerous because of the risks of perforation.