Zenker's Diverticulum Presenting With Complete Esophageal Obstruction in a 55-Year-Old Male

Zenker's diverticulum is an outpouching of mucosa through Killian's dehiscence secondary to increased intraluminal pressure. It typically affects older adults, particularly males over the age of 60. Common symptoms include dysphagia, halitosis, regurgitation, and chronic cough. We present an atypical case of Zenker's diverticulum in a younger patient, who presented with shortness of breath and was found to have near-complete esophageal obstruction. A 55-year-old male with a history of hypertension presented to the emergency room with progressive shortness of breath. Gastroenterology was consulted for several months of dysphagia to both solids and liquids, accompanied by a 25 lb unintentional weight loss. He denied prior food bolus impaction. Initial evaluation included a video fluoroscopic swallow study with recommendations of a liquid diet. An esophagram revealed a large Zenker's diverticulum causing near-complete obstruction of the upper thoracic esophagus. Esophagogastroduodenoscopy (EGD) demonstrated severe upper esophageal stricture with complete obstruction and retained food material. A computed tomography (CT) scan of the soft tissue neck confirmed a large Zenker's diverticulum with significant compression of the proximal esophagus. Otolaryngology was consulted, and the patient underwent an esophagoscopy with transcervical Zenker's diverticulectomy. Postoperative esophagram showed no evidence of a leak. His diet was gradually advanced, and he was discharged in stable condition. This case highlights an uncommon presentation of Zenker's diverticulum, including complete esophageal obstruction and respiratory symptoms in a younger patient. Early identification and a multidisciplinary team were critical for successful outcomes.