ConditionDigestive system
Killian-Jamieson Diverticulum
A Killian-Jamieson diverticulum is a rare outpouching of the upper esophagus, just below the upper esophageal sphincter in the neck. It bulges through a weak spot on the side of the esophagus, usually the left. It is less common and usually smaller than the better-known Zenker's diverticulum, and often causes few symptoms. Larger pouches cause difficulty swallowing, regurgitation of undigested food, cough and bad breath. Small, symptom-free pouches need no treatment; troublesome ones are removed surgically.
Also called: Killian-Jamieson pouch, lateral cervical esophageal diverticulum, proximal lateral cervical esophageal diverticulum
At a glance
- What it is
- A pouch on the side wall of the upper esophagus, below the cricopharyngeus muscle.
- How common
- Rare; roughly a quarter as common as Zenker's diverticulum.
- Symptoms
- Often none; swallowing difficulty, regurgitation, cough, neck fullness.
- Diagnosis
- Barium swallow X-ray, endoscopy, CT.
- Treatment
- Observation for small pouches; surgical removal through the neck for symptomatic ones.
When to get help
Call 911 or go to the ER
- Food stuck in the throat with inability to swallow saliva or difficulty breathing
- Vomiting blood or severe chest or neck pain after swallowing
See a doctor within a day or two
- Cough, fever and breathlessness in someone with known regurgitation (possible aspiration pneumonia)
- Rapid weight loss or inability to keep food down
Book a routine appointment
- Difficulty swallowing, food sticking in the throat, or regurgitating undigested food
- Gurgling in the neck, persistent bad breath, or coughing after meals
- Hoarseness lasting more than 3 weeks
Where the pouch forms
The upper esophagus has a few natural weak points in its muscle wall. A Killian-Jamieson diverticulum forms through the Killian-Jamieson area, a gap on the side of the esophagus just below the cricopharyngeus muscle (the upper esophageal sphincter), near where the recurrent laryngeal nerve enters the throat.
By contrast, a Zenker's diverticulum forms through Killian's triangle, a weak area at the back of the throat just above the cricopharyngeus.
Killian-Jamieson vs Zenker's diverticulum
| Killian-Jamieson | Zenker's | |
|---|---|---|
| Location | Side (usually left) of upper esophagus, below the sphincter | Back of the throat, above the sphincter |
| Frequency | Rare | More common |
| Size | Usually smaller | Often larger |
| Symptoms | Often mild or none | Regurgitation and swallowing problems common |
| Link with sphincter dysfunction | Less clear | Strong link with a tight cricopharyngeus |
| Usual treatment | Open surgical removal through the neck | Endoscopic or open treatment |
Both occasionally occur together.
Symptoms
Many Killian-Jamieson diverticula are found by chance on imaging done for other reasons. When symptoms occur, they include:
- difficulty swallowing, with food sticking in the throat
- regurgitation of undigested food, sometimes hours after eating
- coughing or choking during or after meals
- bad breath
- a feeling of a lump or fullness in the neck
- hoarseness, rarely, from irritation of the nearby recurrent laryngeal nerve
Causes
The exact cause is uncertain. It is thought to result from weakness in the muscle wall at the Killian-Jamieson area combined with increased pressure in the upper esophagus during swallowing. It is most often diagnosed in older adults.
Diagnosis
- Barium swallow (esophagram): the key test. Side views show a pouch projecting from the side of the upper esophagus below the cricopharyngeus.
- Upper endoscopy: looks inside and rules out other causes of swallowing problems. The pouch must be recognized to avoid accidental perforation during the procedure.
- CT scan: sometimes used to show the pouch and its relation to nearby structures, and to distinguish it from a thyroid nodule.
- Esophageal manometry: may be used to assess sphincter and esophageal function.
Treatment
Observation
Small diverticula that cause no symptoms do not need treatment. Eating slowly, chewing thoroughly and drinking water with meals may help mild symptoms.
Surgery
For symptomatic or large diverticula, the standard treatment is open surgical diverticulectomy through an incision in the neck, removing the pouch and closing the wall. Because the recurrent laryngeal nerve lies close by, surgeons take care to identify and protect it. A myotomy (cutting the sphincter muscle) may be added.
Endoscopic techniques, widely used for Zenker's diverticulum, are used less often for Killian-Jamieson diverticula because of the pouch's position and the nearby nerve, though some specialist centers use them in selected cases.
Complications
- aspiration of pouch contents into the lungs, causing aspiration pneumonia
- weight loss and malnutrition
- perforation during endoscopy or tube placement
- after surgery: hoarseness from nerve injury or a leak from the repair, both uncommon in experienced hands
Frequently asked questions
What is a Killian-Jamieson diverticulum?
It is a rare pouch that bulges out from the side of the upper esophagus, just below the upper esophageal sphincter in the neck. It is usually small and may cause no symptoms, but larger pouches can cause swallowing problems and regurgitation.
How is it different from Zenker's diverticulum?
Zenker's forms at the back of the throat above the upper esophageal sphincter and is more common and usually larger. Killian-Jamieson forms on the side, below the sphincter, is rarer, and is more often treated with open surgery rather than endoscopically.
Does a Killian-Jamieson diverticulum need surgery?
Not always. Small diverticula without symptoms can simply be monitored. Surgery is recommended when the pouch causes swallowing difficulty, regurgitation, aspiration or weight loss.
Can a Killian-Jamieson diverticulum cause cancer?
Cancer arising in an esophageal diverticulum is very rare. The main concerns are swallowing problems and aspiration. Any new or worsening swallowing difficulty should still be evaluated to rule out other causes.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Gastroenterology: Esophageal diverticula
- Society of American Gastrointestinal and Endoscopic Surgeons: Esophageal diverticula
- MedlinePlus: Swallowing problems
- Radiological Society of North America (RadioGraphics): Pharyngoesophageal diverticula
- Merck Manual Professional Version: Esophageal diverticula