ABSTRACT
Esophageal duplication cysts are rare congenital noncancerous growths. Symptoms of this disease are reported to be asymptomatic in approximately 70% but include respiratory symptoms such as coughing and difficulty breathing. Minimally invasive removal of these cysts without esophagectomy is typically recommended. However, when the cyst is situated in the upper mediastinum, surgical excision becomes technically challenging. Here, we report a case of an obese female patient with esophageal duplication cyst in the upper mediastinum who underwent successfully robotic-assisted complete removal of the cyst. A 50-year-old woman presented to a local clinic with a persistent cough and hoarseness lasting 4 months. A computed tomography scan revealed a large cystic tumor in the upper mediastinum, causing displacement of the trachea. The resection of the cystic tumor was safely performed with robotic assistance. The use of robotic system for the removal of esophageal duplication cyst is technically safe and feasible.
Subject(s)
Esophageal Cyst , Robotic Surgical Procedures , Humans , Female , Middle Aged , Robotic Surgical Procedures/methods , Esophageal Cyst/surgery , Esophageal Cyst/diagnostic imaging , Esophageal Cyst/complications , Esophageal Cyst/congenital , Esophagus/surgery , Esophagus/abnormalities , Esophagus/diagnostic imagingABSTRACT
ABSTRACT: Esophageal duplication cysts are rare congenital anomalies that are often symptomatic because of compression of surrounding structures. They are commonly diagnosed during childhood, with affected patients often presenting with abdominal pain or chest pain. Point-of-care ultrasound can be used as part of the emergency department evaluation of pediatric chest pain. We present a case of a 6-year-old boy who presented to the emergency department with worsening abdominal and chest pain, where point-of-care cardiac ultrasound identified a cystic structure in the posterior mediastinum.
Subject(s)
Esophageal Cyst , Point-of-Care Systems , Abdomen , Chest Pain , Child , Esophageal Cyst/diagnostic imaging , Esophageal Cyst/surgery , Humans , Male , UltrasonographyABSTRACT
BACKGROUND: Esophageal duplication cysts are a rare congenital cystic malformation from faulty intrauterine recanalization of the esophagus during the 4-8th weeks of development. They account for 20% of all gastrointestinal duplication cysts and commonly involve the distal esophagus. Presenting symptoms may be related to size and location. MATERIALS AND METHODS: Following the PRISMA guidelines, a systematic review was performed by searching published literature in various databases. Data from 97 reported case reports were pooled to present a descriptive and statistical analysis. RESULTS: Patient population was composed of 51(52.5%) males and 46 (47.5%) females, and mean ages was 42.3 years (18-77). Distal cysts were the most prevalent. Seventy-nine (81.4%) patients were symptomatic; common symptoms included dysphagia, chest pain, cough and weight loss. Fifteen (15.5%) patients were treated conservatively and 75 (84.5%) by surgical treatment, among them thoracotomy in 30 (30.9%) patients and VATS in 17 (17.5%) patients. Mean length of hospital stay was 8.6 days (range: 1-26 days). One fatality was registered. Location, unlike size, was not found to influence presenting symptoms or treatment employed. Frequency of conservative treatment was not significantly different between symptomatic and asymptomatic patients. Open approaches were associated with longer stays than their minimally invasive counterparts. CONCLUSION: Esophageal duplication cysts remain rare in adults and are frequently located in the distal esophagus. Larger cysts are more likely to cause symptoms. Various surgical techniques may successfully be employed in the treatment of this pathology. Minimally invasive procedures have a shorter hospital stay.
Subject(s)
Deglutition Disorders , Esophageal Cyst , Adolescent , Adult , Aged , Esophageal Cyst/diagnostic imaging , Esophageal Cyst/surgery , Female , Humans , Length of Stay , Male , Middle Aged , Thoracotomy , Young AdultABSTRACT
Esophageal bronchogenic cysts are rare, and since a limited number of cases has been reported, the treatment plan for asymptomatic patients is difficult. A 55-year-old man without any symptoms visited our hospital for further examination of an esophageal mass detected on simple computed tomography. Upper endoscopy showed the protruding, submucosal mass covered by normal mucosa, and endoscopic sonography confirmed hypoechoic lesions originating from the muscularis propria. The patient was diagnosed as having an esophageal duplication cyst and underwent thoracoscopic resection. Pathological findings were consistent with an esophageal bronchogenic cyst. The patient was discharged without any problems on the 6th postoperative day. Upper endoscopy was performed 6 months after surgery, and no evidence of esophageal diverticula or narrowing was present. In conclusion, early thoracoscopic resection of esophageal bronchogenic cysts, before appearance of the symptom, can be a considerable treatment option because it is less invasive and may be advantageous for obtaining a definitive diagnosis in patients who are candidates for safe surgical resection.
Subject(s)
Bronchogenic Cyst , Esophageal Cyst , Esophageal Neoplasms , Bronchogenic Cyst/diagnostic imaging , Bronchogenic Cyst/surgery , Endosonography , Esophageal Cyst/diagnostic imaging , Esophageal Cyst/surgery , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Humans , Male , Young Adult , Esophageal Perforation , Intestinal Perforation/diagnostic imaging , Intestinal Perforation/surgery , Esophageal Cyst/complications , Mediastinitis/diagnostic imaging , Esophageal Cyst/diagnostic imaging , Chest Pain/etiology , Deglutition Disorders/complications , Leukocytosis , Polymerase Chain Reaction , Mediastinitis/complications , Superinfection , Endoscopy , BiopsyABSTRACT
BACKGROUND: Intramural esophageal bronchogenic cyst is very rare. Surgical removal of the cysts is advised even the patients are asymptomatic, since the cyst can lead to complications, and there is a risk of malignant transformation. Thoracotomy or thoracoscopy is the most commonly used approach for complete excision of the cysts. To our knowledge, this is the first report to excise intramural esophageal bronchogenic cyst completely by endoscopic submucosal tunnel dissection (ESTD). CASE PRESENTATION: A 40-year-old male was referred to our hospital due to the detection of a submucosal tumor at the distal esophagus. The tumor was found during gastroendoscopy in a general health check-up. The patient had no symptoms. A benign esophageal tumor was confirmed by endoscopic ultrasonography (EUS) and computed tomography (CT). On the basis of these results, ESTD was performed. During the procedure, a cystic mass was observed between the mucosa and the muscular layers of the esophagus, and a hybrid knife was used for dissection. Histopathological examination showed the cyst wall was lined by pseudostratified ciliated columnar epithelium, consistent with a bronchogenic cyst. The esophagography using meglumine diatrizoate showed no leakage on the seventh day after ESTD. The patient remained asymptomatic and had a regular diet during the follow-up period. DISCUSSION AND CONCLUSIONS: We successfully utilized ESTD for complete removal of esophageal bronchogenic cysts originating from the muscularis propria. The approach appeared safe, providing a minimally invasive treatment option for patients.
Subject(s)
Bronchogenic Cyst/surgery , Endoscopic Mucosal Resection/methods , Esophageal Cyst/surgery , Adult , Bronchogenic Cyst/diagnostic imaging , Esophageal Cyst/diagnostic imaging , Esophagoscopy , Humans , Male , Tomography, X-Ray Computed , UltrasonographyABSTRACT
A 71-year-old man came to our hospital for endoscopic treatment of a suspicious early gastric carcinoma. A 0.6×0.4 cm protrusive esophageal lesion with smooth surface was found accidentally, located at about 20 cm from the incisors. The lesion was successfully resected by endoscopic mucosal resection, which was esophageal cyst containing heterotopic gastric glands.
Subject(s)
Choristoma/pathology , Esophageal Cyst/pathology , Gastric Mucosa , Aged , Choristoma/diagnostic imaging , Endosonography , Esophageal Cyst/diagnostic imaging , Humans , Incidental Findings , MaleABSTRACT
Esophageal surgery has been recognized as very challenging for surgeons and risky for patients. Thoracoscopic approach have proved its benefit in esophageal surgery but has some drawbacks as tremor and limited degrees of freedom, contra-intuitive movements and fulcrum effect of the surgical tools. Robotic technology has been developed with the intent to overcome these limitations of the standard laparoscopy or thoracoscopy. These benefits of robotic procedure are most advantageous when operating in remote areas difficult to reach as in esophageal surgery. AIM: The aim of this paper is to present our small experience related with robotic approach in benign and malignant esophageal tumors and critically revise the evidence available about the use of the robotic technology for the treatment of these pathology. Methods: From January 2008 to September 2016 robotic surgery interventions related with benign or malignant esophageal tumors were performed in "Dan Setlacec" Center for General Surgery and Liver Transplantation of Fundeni Clinical Institute in seven patients. This consisted of dissection of the entire esophagus as part of an abdomino-thoracic-cervical procedure for esophageal cancer in 3 patients and the extirpation of an esophageal leiomyoma in 3 cases and a foregut esophageal cyst in one case. Results: All procedures except one were completed entirely using the da Vinci robotic system. The exception was the first case - a 3 cm leiomyoma of the inferior esophagus with ulceration of the superjacent esophageal mucosa. Pathology reports revealed three esophageal leiomyoma, one foregut cyst and three squamous cell carcinomas with free of tumor resection margins. The mean number of retrieved mediastinal nodes was 24 (22 - 27). The postoperative course was uneventful in four cases, in the other three a esophageal fistula occurred in the converted leiomyoma case (closed in the 14th postoperative day), a prolonged drainage in one esophageal cancer case and a temporary right recurrent nerve palsy in an other one. One patient with esophageal cancer and all patients with benign lesions are alive with no signs of recurrence and no symptomatology. CONCLUSION: Our experience is limited and we cannot conclude for the long term benefits of robotic surgery for esophageal tumors. In our experience the early outcomes were better then using classic open approach, but similar with the cases performed by thoracoscopic approach. We have noticed significant advantages of robotic surgery in relation of lymph node retrieval, leiomyoma dissection safe from esophageal mucosa and suturing. Ergonomics for the surgeon was incomparable better then with the thoracoscopic approach.
Subject(s)
Adenocarcinoma/surgery , Esophageal Cyst/surgery , Esophageal Fistula/etiology , Esophageal Neoplasms/surgery , Esophagectomy/adverse effects , Leiomyoma/surgery , Robotic Surgical Procedures/instrumentation , Adenocarcinoma/diagnostic imaging , Adult , Body Mass Index , Diabetes Complications/surgery , Esophageal Cyst/diagnostic imaging , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/surgery , Esophageal Neoplasms/diagnostic imaging , Female , Humans , Leiomyoma/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Risk Factors , Robotic Surgical Procedures/methods , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Deglutition Disorders/diagnostic imaging , Endoscopy, Gastrointestinal/methods , Esophageal Cyst/diagnostic imaging , Lung Diseases/complications , Lung Diseases/diagnostic imaging , Deglutition Disorders/complications , Deglutition Disorders/pathologySubject(s)
Deglutition Disorders/etiology , Esophageal Cyst/complications , Aged , Chronic Disease , Conservative Treatment , Endoscopy, Digestive System , Esophageal Cyst/diagnostic imaging , Gases , Humans , Male , Pulmonary Disease, Chronic Obstructive/complications , Risk Factors , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Esophageal duplication cysts (EDCs) are rare congenital anomalies that can be associated with symptomatic spinal abnormalities, but presentations due to EDC symptoms are rarely found in the presence of spinal abnormalities. CASE SUMMARY: A 6-month-old infant weighing approximately 5.0âkg presented with a 2-month pulmonary infection and more recent difficulty swallowing and nutritional intolerance that did not improve with medical treatment. Contrast-enhanced chest computed tomography showed a well-defined, mediastinal, homogeneous, low-density cystic mass of 11.9â×â5.5â×â5.1âcm, compressing the liver and bending the trachea forward. Hemivertebrae were present (T4 and T3). Diagnostic laparoscopy was performed, but was converted to open surgery. After ensuring that the cyst was not within the abdominal cavity, thoracotomy was performed, and the cyst was completely resected. Pathophysiological examination revealed an EDC. The patient recovered well, without symptoms 6 months later. CONCLUSIONS: Overall, noninvasive imaging and diagnostic procedures may not be sufficient to define the exact location of an EDC. Although hemivertebrae were present, they were asymptomatic and did not require treatment; only the EDC induced nonspecific symptoms that disappeared after surgery.
Subject(s)
Esophageal Cyst/congenital , Esophageal Cyst/diagnostic imaging , Humans , Imaging, Three-Dimensional , Infant , Male , Thoracic Vertebrae/abnormalities , Thoracic Vertebrae/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Oesophageal pseudodiverticula rarely occur after excision of benign oesophageal neoplasms. While management and outcomes have been reported in the adult leiomyoma literature, sparse data exist on the occurrence and management of pseudodiverticula after foregut duplication cyst excision. We discuss our experience with a paediatric patient and review relevant literature regarding operative techniques and surgical outcomes.
Subject(s)
Digestive System Abnormalities/surgery , Diverticulum, Esophageal/surgery , Esophageal Cyst/surgery , Esophagus/surgery , Mediastinal Cyst/surgery , Child, Preschool , Digestive System Abnormalities/diagnostic imaging , Digestive System Surgical Procedures/adverse effects , Diverticulum, Esophageal/diagnostic imaging , Diverticulum, Esophageal/etiology , Esophageal Cyst/congenital , Esophageal Cyst/diagnostic imaging , Esophagus/abnormalities , Esophagus/diagnostic imaging , Female , Humans , Mediastinal Cyst/diagnostic imagingABSTRACT
Esophageal bronchogenic cysts are extremely rare. Here we report a more rare type of both presence of intra- and paraesophageal bronchogenic cyst that was safely removed via surgical resection. A 31-year-old male patient with space-occupying lesions in the mediastinum suddenly presented with persistent chest pain for 2 days and then transferred to dysphagia >1 week. Preoperative diagnosis is difficult. Endoscopic ultrasonography (EUS) showed a hypoechoic cystic-solid mass arising from the muscularis propria and local hyperechoic area in the deeper portion of cyst, concomitant with a heterogeneous center and tube-like structure lesion in mediastinum. Turbid coffee color paste contents were aspirated inside the tumor under endoscopic ultrasonography guided-fine needle aspiration (EUS-FNA). A subsequent surgery was performed and histologic finding was diagnostic of esophageal bronchogenic cyst. Immunohistochemical staining confirmed the cyst was positive for carbohydrate antigen 199 (CA199) and carbohydrate antigen 125 (CA125). At a follow-up visit 3 months later, the patient had a regular diet and no complaint. This study is to summarize the clinical manifestations and EUS features of esophageal bronchogenic cyst by retrospectively reviewing the literature and simultaneously to provide guide for the correct examination scheme. The appearance of esophageal bronchogenic cyst can be great variation; EUS seems to be a valuable option for diagnosis and surveillance.
Subject(s)
Bronchogenic Cyst/diagnostic imaging , Endosonography , Esophageal Cyst/diagnostic imaging , Adult , Bronchogenic Cyst/pathology , Bronchogenic Cyst/surgery , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Esophageal Cyst/pathology , Esophageal Cyst/surgery , Humans , MaleABSTRACT
Esophageal duplication cysts are rare congenital abnormalities of the foregut and may be associated with other conditions. Association of esophageal duplication with Gastro-Esophageal Reflux Disease (GERD) has not been reported in children. We are reporting a case of a 16 months baby who had antenatal diagnosis of diaphragmatic hernia. Postnatal CTchest, however, suggested a distal esophageal duplication cyst and a contrast esophagogram showed grade-IV GER. A thoracoscopy in another hospital excluded esophageal duplication at that time. Later, he presented with hematemesis in our department and was re-evaluated. Repeat CTconfirmed a persistent 2.5 x 1.3 cm cyst in distal esophagus. Upper GI endoscopy suggested grade-II esophagitis with a wide patent gastro-esophageal junction. The child was treated with left thoracotomy, excision of the duplication cyst and thoracic fundoplication. He had an uneventful post-operative recovery and is doing well at 6 months follow-up.