Thoracoscopic resection of thoracic esophageal duplication cyst containing ectopic pancreatic tissue in adult
© Takemura et al; licensee BioMed Central Ltd. 2011
Received: 8 August 2011
Accepted: 25 September 2011
Published: 25 September 2011
Esophageal duplication cyst is a rare congenital anomaly. They can be associated with other congenital anomalies, such as spinal abnormalities, and tracheoesophageal fistulas. In adults, almost of the patients with esophageal duplication cyst is asymptomatic and accidentally diagnosed by chest X-ray or computed tomography. However, cysts may become symptomatic owing to complications such as esophageal stenosis, respiratory system compression, rupture, infarction, or malignancy. Complete surgical resection is the standard treatment even in patients with asymptmatic cysts. Traditional approach for resection is via thoracotomy. But, the thoracoscopic approach makes more indicate for mediastinal diseases, because of minimally invasive for patients. We describe a case with esophageal duplication cyst, which contained the ectopic pancreatic tissue in the solid portion, resected under the thoracoscopic approach in adult.
Keywordsesophageal duplication cyst thoracoscopic surgery ectopic pancreas
In adults, the patients with esophageal duplication cysts are asymptomatic and accidentally diagnosed on chest X-ray photograph or computed tomography. Cysts may become symptomatic owing to various complications such as esophageal stenosis, respiratory system compression, rupture, infarction, or malignancy [1–5]. Definitive treatment involves complete surgical resection of the cysts via thoracotomy, even in asymptomatic [6, 7]. But, in recent years, the thoracoscopic approach makes more indicate for mediastinal diseases [8, 9].
In this report, we describe a case of esophageal duplication cyst, which contained the ectopic pancreatic tissue in the solid portion of cyst, was resected under the thoracoscopic approach in a young adult.
The esophageal duplication cysts estimated at 20% of alimentary tract duplications, make it the second most common site [1, 2]. In adults, esophageal duplication cysts usually are diagnosed incidentally because of most cases has asymptomatic. However, they become symptomatic when complications occur, such as obstruction, rupture, hemorrhage, infection and rarely developed malignancies [3–5]. The esophageal duplication cysts arise from the foregut embryologically. Lower respiratory system, esophagus, stomach, hepatobiliary system, and pancreas developed from foregut. So, the esophageal duplication cysts may contain these components pathologically. Actually, ectopic gastric mucosa in esophageal duplication cysts was found in 43% . However, esophageal duplication cysts with pancreas components are rare . Qazi et al  reported the resected case with esophageal duplication cyst complained the recurrent retrosternal pain. In this case, the cyst contained pancreatic components in the solid portion pathologically. They suggested that the destructive action of pancreatic enzyme contributes to the patient symptoms. Our case demonstrated recurrent episode of chest pain, too. The secretory actions of pancreatic tissue might have related to her symptoms.
Definitive treatment of esophageal duplication cyst is complete surgical resection. Conventional approach is under thoracotomy or laparotmy [1, 6]. Moreover, recent advances in minimally invasive surgery have led to less traumatic approach for the treatment of benign mediastinal lesions. Actually, many cases with esophageal duplication cysts treated by thoracoscopic technique have been reported [7, 9]. The points that should be careful for resection of the esophageal duplication cyst were 1) preserving the muscle layer, 2) both vegal nerves should be identified and preserved, 3) mucosal integrity should be checked intraoperatively by air insufflation . A thoracoscopic approach can contribution to a precise resection of the cysts as open thoracotomy dose.
In adults, almost of the patients with esophageal duplication cyst is asymptomatic and accidentally diagnosed by chest X-ray or computed tomography. However, cysts may become symptomatic owing to complications such as esophageal stenosis, respiratory system compression, rupture, infarction, or malignancy. In our case, the symptoms may relate to the pancreatic component in the cyst. Even in such cases, thoracoscopic approach was safety and useful procedure.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in Chief of this journal.
- Holcomb GW, Gheissari A, O'Neill JA, Shorter NA, Bishop HC: Surgical management of alimentary tract duplications. Ann Surg. 1989, 209: 167-174. 10.1097/00000658-198902000-00006.View ArticlePubMedPubMed CentralGoogle Scholar
- Macpherson RI: Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics. 1993, 13: 1063-1680. PMID: 8210590View ArticlePubMedGoogle Scholar
- Sundaramoorthi T, Behranwala AA, Codispoti M, Mankad PS: Asymptomatic congenital oesophageal cyst infiltrating the lung: an unusual complication. Eur J Cardiothorac Surg. 2000, 18: 117-119. 10.1016/S1010-7940(00)00443-7.View ArticlePubMedGoogle Scholar
- Neo EL, Watson DI, Bessell JR: Acute ruptured esophageal duplication cyst. Dis Esophagus. 2004, 17: 109-111. 10.1111/j.1442-2050.2004.00385.x.View ArticlePubMedGoogle Scholar
- Singh S, Lal P, Sikora SS, Datta NR: Squamous cell carcinoma arising from a congenital duplication cyst of the esophagus in a young adult. Dis Esophagus. 2001, 14: 258-261. 10.1046/j.1442-2050.2001.00204.x.View ArticlePubMedGoogle Scholar
- Azzie G, Beasley S: Diagnosis and treatment of foregut duplications. Semin Pediatr Surg. 2003, 12: 46-54. 10.1016/S1055-8586(03)70006-7.View ArticlePubMedGoogle Scholar
- Cioffi U, Bonavina L, De Simone M, Santambrogio L, Pavoni G, Testori A, Peracchia A: Presentation and surgical management of bronchogenic and esophageal duplication cysts in adults. Chest. 1998, 113: 1492-1496. 10.1378/chest.113.6.1492.View ArticlePubMedGoogle Scholar
- Herbella FA, Tedesco P, Muthusamy R, Patti MG: Thoracoscopic resection of esophageal duplication cysts. Dis Esophagus. 2006, 19: 132-134. 10.1111/j.1442-2050.2006.00552.x.View ArticlePubMedGoogle Scholar
- Kang CU, Cho DG, Cho KD, Jo MS: Thoracoscopic stapled resection of multiple esophageal duplication cysts with different pathological findings. Eur J Cardiothorac Surg. 2008, 34: 216-218. 10.1016/j.ejcts.2008.04.019.View ArticlePubMedGoogle Scholar
- Qazi FM, Geisinger KR, Nelson JB, Moran JR, Hopkins MB: Symptomatic congenital gastroenteric duplication cyst of the esophagus containing exocrine and endocrine pancreatic tissues. Am J Gastroenterol. 1990, 85: 65-67.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.