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Where's the ulcer? Spontaneous bleeding from Zenker's diverticulum
Nitin Sardana1, Dustin Wallace1, Radheshyam Agrawal1
1Division of Gastroenterology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
BMJ Case Reports
|June 12, 2014
Summary
This case study highlights a rare cause of severe upper gastrointestinal bleeding: Zenker's diverticulum. Prompt management, including INR reversal and packed red blood cells, successfully treated the patient's life-threatening hemoptysis.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Background:
- Zenker's diverticulum is a rare outpouching of the pharyngeal mucosa.
- It can present with diverse symptoms, including dysphagia and upper gastrointestinal bleeding.
Observation:
- An 89-year-old male presented with hemoptysis and a history of dysphagia.
- He was hypotensive with significant anemia and an elevated International Normalized Ratio (INR).
- Esophagogastroduodenoscopy revealed active bleeding from Zenker's diverticulum.
Findings:
- Bleeding was controlled after reversing the patient's INR with fresh frozen plasma and administering packed red blood cells.
- A barium swallow confirmed a large Zenker's diverticulum (9 cm).
- The patient underwent successful diverticulectomy and cricopharyngeal myotomy.
Implications:
- Zenker's diverticulum should be considered in the differential diagnosis of upper gastrointestinal bleeding, especially in elderly patients with dysphagia.
- Timely diagnosis and management, including surgical intervention, are crucial for favorable outcomes.
- This case underscores the importance of comprehensive diagnostic evaluation for unexplained bleeding.
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