VCOM Louisiana Research Day Program Book 2024

possible interstitial edema. The Pt received a CT of the head without contrast to rule out head injury from the patients frequent falls. TO treat the pneumonia, the patient was started on IV antibiotics. The patient also received a CT of the chest, that demonstrated a large lower cervical esophageal diverticulum at approximately C5. Two days later, the patient underwent an XR pharyngogram, which demonstration tracheal aspiration with both thin and nectar consistencies secondary to a large esophageal diverticulum in the mid top distal esophagus with associated mild rightward displacement of the trachea and esophagus. Radiology reported that the diverticulum was likely to originate from the posterior aspect of the esophagus at C5, and that the findings were most consistent wit ha large Zenker’s Diverticulum. Following these results, general surgery was consulted, and cardiac clearance was requested. After three days, cardiac examination and stress testing returned normal results, and the patient and her family continued to express their interest in surgical management. One day following the pharyngogram, the patient underwent Zenker diverticulectomy with myotomy and PEG placement in addition to a thyroidectomy/ lobectomy due to size. The patient returned from surgery and saw some improvement in symptoms, but began to experience respiratory distress two days post-operatively. The patient was continued on empiric IV antibiotics, and imaging was conducted to investigate. Repeat chest xrays demonstrated improvement of the patients symptoms and proper positioning of the patients G-tube on post operative days five, seven, and twelve. The patient was discharged 13 days after surgery and 21 days after initial

admission with improvement in symptoms and functioning. Conclusions: Overall, this report will contribute to the wealth of knowledge surrounding the diagnosis and management of large Zenker’s Diverticulum. Our current case differs from other cases in that the patient presented initially with disorientation and respiratory symptoms. While pneumonia is a noted symptom of this pathology, much more common presenting symptOMS-Include dysphagia (98%), regurgitation, and halitosis (Nehring & Krasnodebski, 2013; Nesheiwat, 2022). Furthermore, the size of the Zenker’s diverticulum was large, measuring greater than 4cm. More frequently they are smaller. Furthermore, the patient underwent an open diverticulectomy with myotomy. Though endoscopic technique is currently becoming more utilized, this case demonstrates the open-surgical technique that may be needed for patients who are not candidates for endoscopic repair, such as for those who have multiple comorbidities (such as our patient), or who have already undergone the procedure (the endoscopic approach carries a higher recurrence rate) (Marshall et al., 2019)

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