Question:medium
What is the treatment of choice for an old man who has reflux of foul smelling food?
What is the treatment of choice for an old man who has reflux of foul smelling food?
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Foul smelling food regurgitation in an elderly man points to a pharyngeal pouch, treated by myotomy with sac excision.
Updated On: Jul 8, 2026
- Cricopharyngeal myotomy
- Sac removal
- Laser evaporation
- Myotomy with sac excision
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The Correct Option is D
Solution and Explanation
Step 1: Translate the symptoms into a diagnosis.
An old man bringing up smelly, undigested food points straight to a pharyngeal pouch, Zenker's diverticulum, a pocket that forms in the throat wall and stores swallowed food.
Step 2: Understand the two problems that need fixing.
There are really two issues here. First, the cricopharyngeus muscle is tight and does not relax properly during swallowing, which is what pushed the pouch out in the first place. Second, the pouch itself, once formed, keeps collecting food regardless of what happens to the muscle.
Step 3: See why fixing only one problem is not enough.
Cutting the muscle alone relieves the pressure but leaves the sac hanging there to keep trapping food. Taking out the sac alone leaves the tight muscle in place, which can push a new pouch out again over time or strain the repair line.
Step 4: Consider the laser option.
Laser or endoscopic stapling techniques exist and can work, especially in frail patients, but they are a special situation approach rather than the default treatment of choice being tested here.
Step 5: Combine both fixes.
Doing a myotomy to release the muscle spasm and excising the sac in the same sitting deals with both the cause and the pouch itself, which is why this combined operation is the standard answer.
Step 6: Conclude.
\[ \boxed{\text{Myotomy with sac excision}} \]
An old man bringing up smelly, undigested food points straight to a pharyngeal pouch, Zenker's diverticulum, a pocket that forms in the throat wall and stores swallowed food.
Step 2: Understand the two problems that need fixing.
There are really two issues here. First, the cricopharyngeus muscle is tight and does not relax properly during swallowing, which is what pushed the pouch out in the first place. Second, the pouch itself, once formed, keeps collecting food regardless of what happens to the muscle.
Step 3: See why fixing only one problem is not enough.
Cutting the muscle alone relieves the pressure but leaves the sac hanging there to keep trapping food. Taking out the sac alone leaves the tight muscle in place, which can push a new pouch out again over time or strain the repair line.
Step 4: Consider the laser option.
Laser or endoscopic stapling techniques exist and can work, especially in frail patients, but they are a special situation approach rather than the default treatment of choice being tested here.
Step 5: Combine both fixes.
Doing a myotomy to release the muscle spasm and excising the sac in the same sitting deals with both the cause and the pouch itself, which is why this combined operation is the standard answer.
Step 6: Conclude.
\[ \boxed{\text{Myotomy with sac excision}} \]
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