Laparoscopic Enucleation of Schwannoma Masquerading as a Leiomyoma

Abstract

We present a case, literature review, and video of a transabdominal laparoscopic enucleation of an esophageal schwannoma. A 53-year-old female with dysphagia was found to have a 23 × 27 mm mass in the lower esophagus, which was initially diagnosed as a leiomyoma on endoscopic ultrasound without biopsy. At the time of her laparoscopic enucleation 12 months later, the lesion had grown to 60 × 55 × 30 mm and was excised with a full-thickness segment of the esophageal wall, with closure of the resulting defect over a bougie. Postoperatively, the patient’s recovery was complicated by an esophageal leak which was successfully managed with endoscopic drainage. Esophageal schwannomas are rare esophageal lesions that have historically been treated with esophagectomy. Thoracoscopic or laparoscopic enucleations of smaller lesions have been more recently reported but larger lesions have usually required open surgery. Internally placed endoscopic drains have previously been shown to be a valid alternative to external drainage in patients with contained collections after resection surgery. They have the advantage of allowing patients to continue oral fluids during the recovery phase rather than relying on enteral or parenteral feeding. We propose that laparoscopic transabdominal enucleation of esophageal schwannoma with closure of the resulting full-thickness defect be considered as an organ and function sparing alternative for the management of large lower esophageal schwannomas. We further propose that contained leaks resulting from esophageal operations can successfully be managed with internal endoscopic drainage. J Med Cases. 2017;8(7):215-218 doi: https://doi.org/10.14740/jmc2823w