Resection of esophageal duplication cyst in a 6-month child: a surgical challenge by video-assisted thoracoscopic surgery VATS

Abstract

Introduction and importance: Esophageal duplication cysts (EDCs) are rare congenital entities, with an incidence of 1:100,00. The majority of patients are asymptomatic and lesions are usually found incidentally on imaging. However, these cysts were removed via open surgery. Nowadays, video-assisted thoracoscopy surgery (VATS) is an alternative safe method to remove ECDs. Case presentation: Here we present a 6-month-child male complaining of shortness of breath, stridor associated with cough, repeated vomiting, and fever. Furthermore, laboratory test results are within normal limits. Chest x-ray showed well-defined soft tissue density on the right upper and middle lobe with normal lung field, and computed tomography scan revealed that cystic lesion measuring 7×3 cm extended from the thyroid cartilage downward to the posterior mediastinum and toward the right side of the chest causing compression of the trachea, esophagus, and right mainstem bronchus. Finally, the patient was diagnosed with an EDC by histopathologic examination. The patient underwent surgery under general anesthesia by uni-portal VATS through the right fourth intercostal space was performed. The cyst was resected, and an esophageal tear occurred because of the wall of the esophagus as part of the cyst. The patient was discharged on day 11 postoperative. Conclusion: EDC is an exceedingly rare entity. VATS is a less invasive procedure, effective, safe, and has a good clinical outcome compared with open surgical resection. We conclude that EDC should be maintained in the differential diagnosis of unexplained stridor, wheeze, and recurrent chest infection in children.