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Esophageal duplication cyst containing a foreign body
Insights
Esophageal duplication cysts, rare in children, can cause respiratory distress. Surgical removal is effective, with imaging like CT scans aiding diagnosis, even identifying foreign bodies like a bingo chip.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Esophageal duplication cysts (EDCs) represent 10-15% of alimentary tract duplication cysts.
- These cysts are characterized by their attachment to the alimentary tract, lined by mucous membrane, and possessing smooth muscle.
Observation:
- A 2-year-old child presented with progressive respiratory distress.
- Diagnostic imaging, including chest roentgenography, barium esophagography, and computerized tomography (CT), was utilized.
- CT revealed a foreign body within the cyst, later identified as a bingo chip.
Findings:
- A diagnosis of esophageal duplication cyst was confirmed.
- Surgical excision was performed via a low cervical incision with sternal manubrium splitting.
- Complete mucosal removal is crucial for preventing recurrence if total excision is challenging due to inflammation.
Implications:
- Early diagnosis and surgical intervention are vital for managing pediatric esophageal duplication cysts.
- Advanced imaging techniques like CT are valuable for identifying intraluminal contents and aiding surgical planning.
- Postoperative care involving respiratory support and antibiotics is essential for favorable outcomes.
Abstract:
About 10% to 15% of all duplication cysts in the alimentary tract are esophageal. Esophageal duplication cysts are intimately attached to the alimentary tract, are lined by mucous membrane and have smooth muscle. This paper describes a 2-year-old child who presented with symptoms of progressive respiratory distress. A diagnosis of esophageal duplication cyst was made. At surgery a low cervical incision was made and the sternal manubrium split, thereby providing adequate exposure. The cyst was then removed. The most useful investigations were chest roentgenography and barium esophagography. Computerized tomography showed a small, round foreign body in the middle of the cyst that was subsequently found to be a bingo chip. Communication between the cyst and the esophagus was not obvious at the time of surgery and had not been demonstrated by barium esophagography. When complete excision of the cyst is not possible because of inflammatory reaction all the mucosa must be removed to prevent recurrence. Careful postoperative respiratory support and broad-spectrum antibiotic therapy are recommended.