pseudodiverticulum

A pseudodiverticulum is an outpouching of mucosa and submucosa that protrudes through a defect in the muscularis propria, resulting in a false diverticulum. Unlike true diverticula, pseudodiverticula do not contain all wall layers.

In medical practice, pseudodiverticula are most commonly referred to in the gastrointestinal tract. Colonic pseudodiver­ticula are the typical form described as false diverticula, arising where mucosa and submucosa herniate through weaknesses in the muscular wall, often related to chronic increased intraluminal pressure and age-related changes. The pharyngoesophageal region can also form a pseudodiverticulum, most notably Zenker’s diverticulum, which involves herniation of mucosa and submucosa through Killian’s dehiscence above the cricopharyngeus.

Clinical presentation varies by location. Many colonic pseudodiverticula are asymptomatic, but complications can include diverticulitis, bleeding, perforation, or obstruction. Zenker’s diverticulum typically presents with dysphagia, regurgitation of undigested food, cough, and aspiration.

Diagnosis relies on imaging and endoscopy. Barium studies or CT scans help identify outpouchings and complications; esophagography is used for Zenker’s diverticulum. Endoscopy can be informative but carries risks in inflamed or very large diverticula.

Management is tailored to the site and symptoms. Asymptomatic colonic pseudodiverticula generally require no treatment. Complications such as diverticulitis or bleeding may necessitate antibiotics, drainage, or surgical resection. Zenker’s diverticulum is managed with endoscopic or open diverticulectomy and, often, cricopharyngeal myotomy to improve swallowing.