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Killian–Jamieson diverticulum
Killian–Jamieson diverticulum
	Killian–Jamieson diverticulum. The arrowhead points at the closed upper esophageal sphincter, arrow points at the diverticulum partly filled with contrast medium.
Specialty	Gastroenterology

A Killian–Jamieson diverticulum is an outpouching of the esophagus just below the upper esophageal sphincter.^[1]

The physicians that first discovered the diverticulum were Gustav Killian and James Jamieson. Diverticula are seldom larger than 1.5 cm, and are less frequent than the similar Zenker's diverticula. As opposed to a Zenker's, which is typically a posterior and inferior outpouching from the esophagus, a Killian–Jamieson diverticulum is typically an anterolateral outpouching at the level of the C5-C6 vertebral bodies, due to a congenital weakness in the cervical esophagus between the oblique and transverse fibers of the cricopharyngeus muscle. It is usually smaller in size than a Zenker's diverticulum, and typically asymptomatic.^[2] Although congenital, it is more commonly seen in elderly patients.^[3]

Because of its relatively anterior positioning compared to a Zenker's diverticulum, surgical intervention to fix a Killian-Jamieson diverticulum has a higher risk of injury to the recurrent laryngeal nerve.^[4]

Signs and symptoms

When it comes to Killian-Jamieson diverticulum, the vast majority of patients are asymptomatic.^[5] Dysphagia is the most common presentation for patients. Additional recurrent symptoms include aspiration, halitosis, coughing, globus sensation, and neck pain.^[6]

Causes

It's still unknown what causes Killian-Jamieson diverticulum. Numerous theories have been put forth.^[5] A notable rise in intraluminal pressure was hypothesized by one author as a result of functional outflow obstruction brought on by the circular esophageal muscle contracting.^[1] A different author proposed that there may be a similar pathophysiology between the etiology of Killian-Jamieson diverticulum and Zenker's diverticula.^[7]

Diagnosis

Imaging usually confirms the diagnosis because a barium esophagram can show the location, size, and lateralization of the lesion. Although there are other modalities such as esophageal endoscopy, CT scan, and ultrasound, most clinicians rely on barium esophagram to make clinical decisions.^[8]

Treatment

Expectant management makes sense for asymptomatic patients.^[9] Patients experiencing symptoms can have a variety of surgical options available to them, such as transcervical diverticulectomy combined with esophagomyotomy.^[10]

References

^ ^a ^b Tang, Shou-jiang; Tang, Linda; Chen, Edward; Myers, Larry L. (2008). "Flexible endoscopic Killian-Jamieson diverticulotomy and literature review (with video)". Gastrointestinal Endoscopy. 68 (4): 790–793. doi:10.1016/j.gie.2008.01.005. ISSN 0016-5107. PMID 18402951.
^ O'Rourke, A. K.; Weinberger, P. M.; Postma, G. N. (2012). "Killian-Jamieson diverticulum". Ear, Nose, & Throat Journal. 91 (5): 196. doi:10.1177/014556131209100507. PMID 22614553.
^ Siow, S. L.; Mahendran, H. A.; Hardin, M (2015). "Transcervical diverticulectomy for Killian-Jamieson diverticulum". Asian Journal of Surgery. 40 (4): 324–328. doi:10.1016/j.asjsur.2015.01.007. PMID 25779884.
^ Kim, Dong Chan; Hwang, Jae Joon; Lee, Woo Surng; Lee, Song Am; Kim, Yo Han; Chee, Hyun Keun (August 2012). "Surgical Treatment of Killian-Jamieson Diverticulum". The Korean Journal of Thoracic and Cardiovascular Surgery. 45 (4): 272–274. doi:10.5090/kjtcs.2012.45.4.272. ISSN 2233-601X. PMC 3413838. PMID 22880178.
^ ^a ^b Oh, James; Norris, Ashton; Artigue, Michael; Kruger, Jessica (September 8, 2021). "Killian-Jamieson Diverticulum: Management of a Rare Esophageal Diverticula". Cureus. 13 (9). Cureus, Inc.: e17820. doi:10.7759/cureus.17820. ISSN 2168-8184. PMC 8500250. PMID 34660030.
^ Alnimer, Lynna; Zakaria, Ali; Piper, Michael (March 2, 2021). "Killian Jamieson Diverticulum: A Rare Cause of Dysphagia". Cureus. 13 (3). Cureus, Inc.: e13654. doi:10.7759/cureus.13654. ISSN 2168-8184. PMC 8012179. PMID 33824805.
^ Boisvert, René D; Bethune, Drew CG; Acton, David; Klassen, Denis R (2010). "Bilateral Killian-Jamieson Diverticula: A Case Report and Literature Review". Canadian Journal of Gastroenterology. 24 (3). Hindawi Limited: 173–174. doi:10.1155/2010/701071. ISSN 0835-7900. PMC 2852222. PMID 20352145.
^ Tagliaferri, A. (March 4, 2021). "The role of fluoroscopy in diagnosing a Killian–Jamieson diverticulum". Journal of Community Hospital Internal Medicine Perspectives. 11 (2). Greater Baltimore Medical Center: 228–234. doi:10.1080/20009666.2021.1893144. ISSN 2000-9666. PMC 8043607. PMID 33889326.
^ Yang, Chia-Wei; Yen, Hsu-Heng; Choo, Chung-Ho (2013). "Hematemesis in a Man With Longstanding Esophageal Globus Sensation". Gastroenterology. 144 (3). Elsevier BV: e11 – e12. doi:10.1053/j.gastro.2012.11.003. ISSN 0016-5085. PMID 23380948.
^ Jeismann, Vagner Birk; Bianchi, Edno Tales; Szachnowicz, Sérgio; Seguro, Francisco Carlos Bernal da Costa; Tustumi, Francisco; Duarte, Andre Fonseca; Sallum, Rubens Antonio Aissar; Cecconello, Ivan (June 4, 2019). "Surgical treatment of Killian-Jamieson diverticulum: A case report and literature review". Clinical Case Reports. 7 (7). Wiley: 1374–1377. doi:10.1002/ccr3.2249. ISSN 2050-0904. PMC 6637344. PMID 31360491.