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Dalvi AV, Save M, Kothari P, Gupta A, Deshmukh S, Kulkarni A, Jha S, Shah D. Management of tubular oesophageal duplication - A novel approach. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2022.102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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2
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Abstract
Primary mediastinal cysts are infrequent lesions that can arise from a variety of mediastinal organs or structures. Most of these are congenital in origin and incidental findings during investigations for unrelated conditions. Histologically, the cysts may be composed of various tissues, including bronchogenic, pericardial, thymic, enteric, Müllerian, lymphatic, and parathyroid types. Mediastinal cysts typically demonstrate a benign clinical course and patients are cured after complete surgical resection. In this review, the embryogenesis, clinical, radiologic, and pathologic characteristics of non-neoplastic mediastinal cysts are examined with discussion of the role of immunohistochemistry and the most pertinent differential diagnosis.
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3
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The Pediatric Esophagus. Dysphagia 2018. [DOI: 10.1007/174_2018_180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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4
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Abstract
Esophageal duplication and congenital esophageal stenosis (CES) may represent diseases with common embryologic etiologies, namely, faulty tracheoesophageal separation and differentiation. Here, we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment.
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Affiliation(s)
- A Francois Trappey
- David Grant Medical Center, Travis Air Force Base, California; Division of Trauma, Acute Care Surgery, and Surgical Critical Care, UC Davis Medical Center, Sacramento, California
| | - Shinjiro Hirose
- Department of Surgery, UC Davis Medical Center, Sacramento, California; Division of Pediatric General, Thoracic, and Fetal Surgery, UC Davis Medical Center, Sacramento, California; Shriners Hospitals for Children-Northern California, 2425 Stockton Blvd, Sacramento, California 95817.
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5
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Retrocardiac mediastinal foregut duplication cyst. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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6
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Kawashima S, Segawa O, Kimura S, Tsuchiya M, Henmi N, Hasegawa H, Fujibayashi M, Naritaka Y. A case of cervical esophageal duplication cyst in a newborn infant. Surg Case Rep 2016; 2:30. [PMID: 27037803 PMCID: PMC4818649 DOI: 10.1186/s40792-016-0157-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/28/2016] [Indexed: 12/11/2022] Open
Abstract
Esophageal duplication cyst is a rare congenital anomaly resulting from a foregut budding error during the fourth to sixth week of embryonic development. Cervical esophageal duplication cysts are very rare and may cause respiratory distress in infancy. A full-term newborn girl who was born by normal delivery was transferred to our hospital because of swelling of the right anterior neck since birth. Cervical ultrasonography showed a 40 × 24 × 33 mm simple cyst on the right neck. Tracheal intubation was required at 2 weeks of age because of worsening external compression of the trachea. Fine-needle aspiration cytology revealed the existence of ciliated epithelium. At 1 month of age, exploration was performed through a transverse neck incision. The cyst had a layer of muscle connected to the lateral wall of the esophagus. Histopathological diagnosis was a cervical esophageal duplication cyst. We describe the clinical features of infantile cervical esophageal duplication cysts based on our experience of this rare disease in a neonate, along with a review of 19 cases previously reported in literature.
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Affiliation(s)
- Shoko Kawashima
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan.,Department of Pediatric Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Osamu Segawa
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan. .,Department of Pediatric Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
| | - Shuri Kimura
- Department of Pediatric Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masayoshi Tsuchiya
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan.,Department of Pediatric Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Nobuhide Henmi
- Division of Neonatal Intensive Care, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Hisaya Hasegawa
- Division of Neonatal Intensive Care, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Mariko Fujibayashi
- Department of Diagnostic Pathology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Yoshihiko Naritaka
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan
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7
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Oesophageal duplication cyst mimicking hydatid cyst in endemic areas. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:272-4. [PMID: 26702290 PMCID: PMC4631926 DOI: 10.5114/kitp.2015.54470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 12/31/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022]
Abstract
The cystic appearance of both oesophageal duplications and pulmonary hydatid cysts can cause a misdiagnosis very easily due to rarity of cystic oesophageal duplications beside the higher incidence of hydatid cyst, especially in endemic areas. Here we report a 7-year-old girl with an oesophageal duplication cyst on the left side misdiagnosed as a hydatid cyst. The aim of the study is to report rare oesophageal duplications in the differential diagnosis of intrathoracic cysts.
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8
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Abstract
Duplications of the alimentary tract are rare congenital malformations, with the ileum being the most commonly affected site, followed by the oesophagus. Among oesophageal duplications, cystic duplication is the most common and the tubular variety, the rarest. Herein, we report a rare case of tubular oesophageal duplication, complicated by adenosquamous carcinoma at the lower end of the oesophagus, in a 32-year-old man who presented with progressive dysphagia. Although proton pump inhibitors may relieve dysphagia, oesophagectomy and gastric interpositioning should be the first-line treatment for patients with tubular oesophageal duplication, in order to reduce the risk of malignant transformation at the lower end of the oesophagus.
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Affiliation(s)
- A K Saha
- P-5, Block-B, Lake Town, Kolkata 700089, West Bengal, India.
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10
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Zhang Z, Jin F, Wu H, Tan S, Tian Z, Cui Y. Double esophageal duplication cysts, with ectopic gastric mucosa: a case report. J Cardiothorac Surg 2013; 8:221. [PMID: 24289795 PMCID: PMC4222059 DOI: 10.1186/1749-8090-8-221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 11/25/2013] [Indexed: 12/03/2022] Open
Abstract
Esophageal duplication cyst (EDC) is a congenital malformation of the posterior primitive foregut, which mainly occurs in the thoracic esophagus. Here, we describe a 3-year-old Han Chinese boy afflicted with intermittent fever of acute onset and dry cough. Thoracic computed tomography revealed an 10 cm × 5.4 cm × 5.8 cm oval-shaped, cyst-like tumor located in the extrapleural space, extending along the right paravertebral gutter and compressing the trachea forward. An additional small-sized, oval-shaped cyst was identified in the posterior mediastinum, between the esophagus and the spinal column, at the T1 level. During open thoracotomy, under general anesthesia, an opaque, thick-walled, esophageal cyst was revealed not to be in communication with the esophageal lumen or the trachea. This cyst was subsequently resected in an en bloc manner. The small (1-cm) esophageal cyst was left untreated based on a “wait-and-see” policy. Histological analysis showed that the resected cyst was walled by hyperplastic, fibrous tissues and locally lined with gastric mucosa inherent glands. This finding was consistent with a diagnosis of EDC, with ectopic gastric mucosa. The respiratory tract symptoms resolved immediately after the operation. Computed tomography obtained at the 6-month follow-up showed that no disease, residual or recurrence, was present after the resection of the large-sized cyst, and the small-sized cyst remained unchanged in size.
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Affiliation(s)
- Zhefeng Zhang
- Department of Thoracic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun 130021, China.
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11
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Puri A, Yadav PS, Saha U, Singh R, Chadha R, Choudhary SR. A case series study of therapeutic implications of type IIIb4: a rare variant of esophageal atresia and distal tracheoesophageal fistula. J Pediatr Surg 2013; 48:1463-9. [PMID: 23895955 DOI: 10.1016/j.jpedsurg.2012.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 12/14/2012] [Accepted: 12/14/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND A wide spectrum of variations can occur in type IIIb esophageal atresia and distal tracheoesophageal fistula [EA-TEF] (Kluth D. Atlas of esophageal atresia. J Pediatr Surg 1976; 11 (6):901-19). The aim of this study was to evaluate the variant anatomy of subtype IIIb4 EA-TEF and its therapeutic implications. METHODS We performed a retrospective review of 4 patients of this variant subtype within a series of 259 esophageal atresias, managed over a study period of three years, at our institution. The diagnosis was made at thoracotomy. The overlapping upper and lower esophageal pouches, initially, gave a false impression of esophageal continuity. The long TEF coursed parallel in proximity to the upper pouch (UP) and the trachea needing meticulous dissection. The TEF measured 8-10mm in diameter and was ligated and divided high on the trachea near the thoracic inlet. The patients were followed up by a contrast swallow, radioactive technetium-99m- sulfur colloid scan, echocardiography and bronchoscopy (if indicated). RESULTS The mean birth weight and gestational age was 2250 g and 38 weeks respectively. The mean follow up was eighteen months (range 5-42 months). An associated anorectal malformation was present in two patients while none had associated congenital heart disease. The Waterston grading was A and B in one patient each and C in two patients. All the patients had muscular UP extending up-to the level of arch of azygous vein (T(3-4)). The lower esophageal pouch (LP) and the fistula extended high, near the thoracic inlet. Tracheal injury occurred in one patient, with thin LP, warranting postoperative elective ventilation. A postoperative barium swallow did not reveal anastomotic leak or stricture in any patient. Follow-up barium swallow showed long LP extending high up in the chest, up to clavicles in all four patients and redundancy of UP in case 1. Severe gastroesophageal reflux was present in two patients. Bronchoscopy revealed tracheomalacia in case 1. Three patients were thriving well at the last follow-up. One patient died at five months of age due to aspiration pneumonia. CONCLUSIONS The knowledge of diagnostic and therapeutic implications of the variant subtype IIIb4 EA-TEF should be in the armamentarium of the treating surgeon to reduce pitfalls in its management.
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Affiliation(s)
- Archana Puri
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi-110 001, India.
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12
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Knod JL, Garrison AP, Frischer JS, Dickie B. Foregut duplication cyst associated with esophageal atresia and tracheoesophageal fistula: a case report and literature review. J Pediatr Surg 2013; 48:E5-7. [PMID: 23701808 DOI: 10.1016/j.jpedsurg.2013.02.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 02/12/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
Abstract
A case of esophageal atresia associated with a foregut duplication cyst is reported and the literature reviewed. This is the first documented occurrence in conjunction with Down syndrome and the second case where both anomalies were treated at the initial surgery.
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Affiliation(s)
- J Leslie Knod
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC-2023, Cincinnati, Ohio 45229, USA.
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13
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Owen R, Bowen J. A rare congenital neck lump. BMJ Case Rep 2012; 2012:bcr-2012-006605. [PMID: 22962394 DOI: 10.1136/bcr-2012-006605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case and present a radiological image of a neck lump identified antenatally with ultrasound imaging. Postnatally a left-sided asymptomatic neck lump was identified in the left posterior triangle of the neck. Repeat ultrasound and CT imaging were arranged confirming a cyst adjacent to the cervical oesophagus and displacing the carotid sheath anteriorly. Complete cyst excision was achieved with no complications. Histological analysis identified a 30×22×20 mm cyst with a smooth muscle layer within the cyst wall and a lining of respiratory epithelium. These findings were consistent with a diagnosis of cervical duplication cyst (CDC). Proximity to the carotid sheath and oesophagus can make CDC excision potentially dangerous hence preoperative CT scanning was useful to establish the anatomical relations of the cyst in this case.
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Affiliation(s)
- Richard Owen
- Department of General Surgery, Arrowe Park Hospital, Wirral, UK.
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14
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15
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Benson JE. The Pediatric Esophagus. Dysphagia 2012. [DOI: 10.1007/174_2012_582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Nayan S, Nguyen LHP, Nguyen VH, Daniel SJ, Emil S. Cervical esophageal duplication cyst: case report and review of the literature. J Pediatr Surg 2010; 45:e1-5. [PMID: 20850608 DOI: 10.1016/j.jpedsurg.2010.05.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 05/28/2010] [Accepted: 05/29/2010] [Indexed: 11/29/2022]
Abstract
Cervical esophageal duplication cysts are rare congenital anomalies that can be successfully managed surgically. These anomalies are rare causes of upper airway obstruction. We present here a case of a cervical esophageal duplication cyst in an infant, along with a review of the literature concerning this anomaly.
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Affiliation(s)
- Smriti Nayan
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Canada
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17
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Patron V, Godey B, Aubry K, Jegoux F. Endoscopic treatment of pharyngo-esophageal diverticulum in child. Int J Pediatr Otorhinolaryngol 2010; 74:694-7. [PMID: 20303603 DOI: 10.1016/j.ijporl.2010.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 02/21/2010] [Accepted: 02/22/2010] [Indexed: 11/26/2022]
Abstract
Pharyngo-esophageal diverticula are extremely rare among children. Treatment in adults usually consists of endoscopic resection of the crico-pharyngeal muscle but application of this surgical procedure in children has not been reported before. We report the case of a 5-year-old boy whose recurrent pulmonary infection and chronic low weight led to diagnosis of a pharyngeal diverticulum. The diverticulum was removed by endoscopic CO(2) laser surgery. No relapse occurred during the 4-year follow-up period after surgery.
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Affiliation(s)
- Vincent Patron
- Department of Head and Neck Surgery, Rennes University Hospital Center, 2 rue Henri Le Guillou, 35000 Rennes, France.
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18
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Tröbs RB, Barenberg K, Vahdad MR, Tannapfel A. Noncommunicating tubular duplication of the upper pouch in esophageal atresia without fistula. J Pediatr Surg 2009; 44:1646-8. [PMID: 19635321 DOI: 10.1016/j.jpedsurg.2009.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 04/05/2009] [Accepted: 04/07/2009] [Indexed: 10/20/2022]
Abstract
We report a unique combination of an esophageal atresia without fistula associated with a tubular noncommunicating esophageal duplication. The diagnosis was made at delayed repair and led to a successful outcome.
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Affiliation(s)
- Ralf-Bodo Tröbs
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, D-44627 Herne, Germany.
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Inan M, Basaran UN, Aksu B, Dereli M, Dortdogan Z. Esophageal duplication associated with esophageal atresia and tracheoesophageal fistula in a child. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.pedex.2007.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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González de Zárate Lorente A, Barrio Gómez de Agüero MI, Molina Arias M, Martínez Carrasco MC, Antelo Landeira C. [Gastrointestinal malformations: a cause of chest pain]. An Pediatr (Barc) 2007; 66:309-12. [PMID: 17349259 DOI: 10.1157/13099695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chest pain is an uncommon cause of consultation in childhood and is even less frequent if resulting from digestive causes. We present the cases of two patients with gastrointestinal tract malformations (diverticulum and esophageal duplication cyst) diagnosed after investigation of chest pain. A potential etiology of diverticulum could be a traction effect caused by fibrous adenopathy of tuberculous primary infection. Duplication cysts are inborn defects. Although these malformations are uncommon, clinicians should take them into account in patients with chest pain.
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Abstract
Duplication cysts of the gastrointestinal tract are rare, particularly in adults. Endoscopic minimally invasive treatment is still a challenging approach even in the endoscopically accessible sections of the gastrointestinal tract. In a 25-year-old patient suffering from dysphagia, an endoscopy and subsequent endosonography revealed a spherical duplication cyst in the lower third of the esophagus, which prompted us to puncture the cyst and subsequently to perform a fenestration (marsupialization; diameter 1 cm) in the anterior wall of the cyst, resulting in permanent drainage of the cystic fluid. Because of the recurrent complaints of the patient after 6 weeks, the anterior wall of the duplication cyst, the former esophageal wall, was partially resected, resulting in a permanent 4-cm opening including the cystic cavity into the esophageal lumen. Thereafter, there were no further complaints from the patient and the findings in the follow-up endoscopy were normal. A successful endoscopic intervention for this type of gastrointestinal duplication cyst is described for the first time. The minimally invasive resection of the anterior wall of the esophageal duplication cyst, simultaneously with the former regular wall at this segment of the esophagus, resulted in permanent inclusion of the cystic cavity into the esophageal lumen with no disadvantageous passage of fluid and food through the lower esophagus or changes in the former cystic epithelium. This method is considered to be feasible and a reasonable treatment alternative to the more invasive surgical approach.
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Affiliation(s)
- Uwe Will
- Department of Internal Medicine III, City Hospital, Gera, Germany.
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22
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Abstract
The radiological imaging plays a vital role in the evaluation of patients with congenital anomalies of the gastrointestinal tract. The evaluation of these patients, most of which present early after birth, frequently requires the use of various imaging modalities for making the correct diagnosis and planning surgical correction. This article reviews the common congenital anomalies of the gastrointestinal tract including obstructive lesions, anomalies of rotation and fixation, anorectal anomalies, and intestinal duplications. The plain radiograph is often diagnostic in neonates with complete gastric of upper intestinal obstruction and further radiologic evaluation may be unnecessary. An upper gastrointestinal series should be performed in all patients with incomplete intestinal obstruction. Sonography is useful in the evaluation of many congenital anomalies affecting pediatric gastrointestinal tract especially hypertrophic pyloric stenosis, enteric duplication cysts, midgut malrotation, meconium ileus and meconium peritonitis. Moreover, CT and MRI has assumed a greater importance as these provide excellent anatomic details which may be necessary for correct diagnosis as well as treatment planning. This is particularly true in evaluation of congenital anomalies such as esophageal/enteric duplications, vascular rings and anorectal anomalies. It is important to be familiar with the role nad usefulness of the various imaging modalities so that these can be used judiciously to avoid unnecessary radiation exposure while minimizing the patient discomfort.
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Affiliation(s)
- Arun Kumar Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Qi BQ, Beasley SW, Williams AK. Evidence of a common pathogenesis for foregut duplications and esophageal atresia with tracheo-esophageal fistula. THE ANATOMICAL RECORD 2001; 264:93-100. [PMID: 11505375 DOI: 10.1002/ar.1125] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The pathogenesis of the alimentary tract duplications, including foregut duplications (FgD) remains speculative. The accidental finding of FgD in fetal rats with esophageal atresia and tracheoesophageal fistula (EA-TEF) induced by Adriamycin provided an animal model to investigate a possible relationship between these two entities. Timed-pregnant rats were intraperitoneally injected with Adriamycin (1.75 mg/kg) on gestational Days 6 to 9. Their embryos were harvested by Caesarean section from gestational Days 14 to 21. Forty-six of embryos were processed and serially sectioned in the transverse or sagittal planes. EA-TEF occurred in 43/46 (93%) embryos of which 11 (24%) were found to have an associated FgD located at the level where the esophagus was absent. Six FgDs communicated with the foregut or the trachea. Five noncommunicating FgDs were located between the foregut and the vertebral column. In the control embryo, the notochord was located in the centre of the vertebral column from Day 11 of the gestation. In Day 14, 15 and 16, however, embryos exposed to Adriamycin, an abnormal notochord or branch frequently was located within the mesenchyme of the maldeveloped foregut or attached to the duplication cyst. In some, it appeared that the notochord was drawing the cyst-like structure away from the foregut. The present study confirms that duplications adjacent to the esophagus arise from the foregut and that failure of the foregut to detach from the notochord at the normal time may contribute to the development of foregut duplications.
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Affiliation(s)
- B Q Qi
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
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25
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Abstract
Communicating esophageal duplication and true congenital esophageal diverticulum are entities rarely encountered during childhood. The authors report an unusual case of midesophageal communicating duplication with secondary upper esophageal obstruction.
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Affiliation(s)
- A Gorenstein
- Department of Pediatrics, The Edith Wolfson Medical Center, Holon, Israel
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26
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Berrocal T, Torres I, Gutiérrez J, Prieto C, del Hoyo ML, Lamas M. Congenital anomalies of the upper gastrointestinal tract. Radiographics 1999; 19:855-72. [PMID: 10464795 DOI: 10.1148/radiographics.19.4.g99jl05855] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A wide spectrum of congenital anomalies may affect the upper gastrointestinal tract, including anomalies of the esophagus (e.g., atresia, fistulas, webs, duplications, vascular rings), stomach (e.g., congenital gastric outlet obstruction, duplications), and duodenum (e.g., atresia, annular pancreas, duplications, malrotation). The evaluation of affected patients can require multiple imaging modalities for diagnosis and surgical planning. Radiography is often diagnostic and specific and can usually provide important clues to help determine the optimal diagnostic procedure. Neonates with complete gastric or upper intestinal obstruction do not usually require further radiologic evaluation after radiography: Barium studies are usually contraindicated, and complementary procedures (e.g., ultrasound [US], computed tomography [CT]) are not usually helpful and may even delay surgery, resulting in death. Nevertheless, US has become important in the evaluation of the pediatric gastrointestinal tract and is being used in an increasing number of applications. CT and magnetic resonance imaging are unsuitable for general screening but provide superb anatomic detail and added diagnostic specificity. They are especially useful in demonstrating esophageal duplications and vascular rings as well as associated abnormalities. However, the decision to perform a given imaging examination should be considered carefully to avoid inconvenience or unnecessary radiation exposure to the patient or delays in surgical correction. Quality control programs should be in place to ensure safe, effective radiologic practice through use of up-to-date equipment and good imaging technique.
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Affiliation(s)
- T Berrocal
- Servicio de Radiodiagnóstico, Hospital Infantil La Paz, Madrid, Spain
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27
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Abstract
Rings, webs, and diverticula are among the most common anatomic anomalies of the esophagus. Although these structural lesions are often asymptomatic, patients can develop significant problems with dysphagia, regurgitation, and aspiration. This article discusses the epidemiology, pathogenesis, diagnosis, and therapy of esophageal rings, webs, and diverticula with emphasis on the clinical, diagnostic, and therapeutic strategies involved in caring for patients with these conditions.
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Affiliation(s)
- R W Tobin
- Division of Gastroenterology, University of Washington, Seattle 98195, USA
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