Incidental Zenker's diverticulum during exploration of penetrating neck wound^†

Intraoperative incidental findings are a persistent concern for surgeons. Even when such findings are not overtly life-threatening, surgeons must quickly decide whether to intervene. Esophageal diverticula are rare and underdescribed incidental findings associated with increased morbidity. A 40-year-old man was brought in by EMS after sustaining a penetrating Zone II left anterolateral neck wound. Emergent surgical exploration revealed a full-thickness distal oropharyngeal injury. The endotracheal tube was exposed and a Zenker's diverticulum was identified on the superior edge of the laceration. The diverticulum was excised and oversewn along with the oropharyngeal laceration repair. Intraoperative esophagogastroduodenoscopy leak test and 7-day post-op computed tomography esophagram were negative. Our case describes the first successful management of an incidental Zenker's diverticulum in the literature. The decision to resect the diverticulum allowed for proper repair of the oropharyngeal laceration and improved outcomes by reducing the need for future surgical intervention.