Ans: B (Zenker's diverticulum) Ref: Sethis ton Textbook of Surgery, 19th Edition 1023-4Explanation:Pharyngoesophageal (Zenker's) DiverticulumProtrusion of mucosa and submucosa posteriorly above the cricopharyngeal sphincter through the natural weak point (the dehiscence of Killian ) between the oblique and horizontal (cricopharyngeus) fibres of the inferior pharyngeal constrictor.Most common esophageal diverticulumAlso known as cricopharyngeal achalasiaUsually presents in the seventh decade of lifeDue to loss of tissue elasticity and muscle tone with ageClinical FeaturesOften initially asymptomatic.Sticking sensation in the throat.A nagging cough, excessive salivation, and intermittent dysphagia often are signs of progressive disease.As the sac increases in size, regurgitation of foulsmelling, undigested material occurs .Halitosis, voice changes, retrosternal pain, and respiratory infections - common in older adults.The most serious complication - aspiration pneumonia or lung abscessDiagnosisInvestigation of choice - Barium esophagraphyAt the level of the cricothyroid cartilage, the diverticulum can be seen filled with barium resting posteriorly alongside the esophagus.Lateral views are must because this is usually a posterior structure.Neither esophageal manometry nor endoscopy is needed for diagnosis.ManagementSurgical or endoscopic repair of a Zenker's diverticulum is the gold standard of treatment.Traditionally, an open repair through the left neck was advocated.Endoscopic exclusion has gained popularityDepends on the size of the diverticulumSmall diverticulum (<2 cm), a myotomy of the proximal and distal thyropharyngeus and cricopharyngeus alone is done.5 cm - Diverticulectomy is the treatment of choice In frail patients who may be subject to a higher rate of cervical esophageal leak, a diverticulopexy, without resection, is performed- Between 2 and 5 em- Endoscopic Dohlman procedure. Endoscopic division of the common wall between the esophagus and diverticulum using a laser or stapler.