A 80 year old female presents with complaints of swallowing difficulty, foul breath since 4 months. On auscultation, lung fields had crepitations. Barium swallow finding is shown below. What is your diagnosis?

PHARYNGEAL POUCHAlso called hypopharyngeal diveiculum or Zenker's diveiculum, it is a pulsion diveiculum where pharyngeal mucosa herniates through the Killian's dehiscence--a weak area between two pas of the inferior constrictor.Dysphagia is the prominent feature. It appears after a few swallows when the pouch gets filled with food and presses on the esophagus. The gurgling sound is produced by swallowing.Undigested food may regurgitate at night when the patient is recumbent, causing cough and aspiration pneumonia.The patient is often malnourished due to dysphagia. Patients with pharyngeal pouch may have associated hiatus hernia.Rarely carcinoma can develop in long-standing cases of the pharyngeal pouch.DiagnosisBarium swallow will show the sac and its size.Treatment1. Excision of the pouch and cricopharyngeal myotomy2. Dohlman's procedure. The paition wall between the esophagus and the pouch is divided by diathermy through an endoscope. This is done in poor risk debilitated patients.3. Endoscopic laser treatmentRef: Dhingra; 6th ed; Pg 274