Bronchogenic cyst at esophagogastric junction treated by laparoscopic full-thickness resection and hand-sewn closure: a case report

Abstract

Background: We herein report a case of a bronchogenic cyst arising from the esophagogastric junction treated by laparoscopic full-thickness extirpation. The full-thickness defect was closed by hand sewing a T-shaped line over the gastroendoscope as a bougie to prevent postoperative deformity or stenosis. Partial fundoplication (Toupet fundoplication) was added to prevent reflux.

Case presentation: A 32-year-old woman with a body mass index of 43 kg/m(2) was admitted for treatment of a cyst-forming submucosal tumor (60 mm in diameter) on the anterior wall of the esophagogastric junction, which was detected during screening endoscopy before bariatric surgery. The tumor was an extraluminal growing type but exhibited severe erosion at the mucosal site. A cystic tumor such as a duplication cyst, bronchogenic cyst, or cyst-forming gastrointestinal stromal tumor was suspected, and the abovementioned surgery was carried out. The postoperative course was uneventful. The pathological findings revealed the tumor to be a benign bronchogenic cyst. Endoscopic examination 3 months postoperatively showed no deformity or stenosis, and the patient complained of no reflux symptoms.

Conclusion: This procedure may be an efficient option for treatment of submucosal tumors on the esophagogastric junction to maintain function or avoid excessive surgery.

Keywords: Bronchogenic cyst; Esophagogastric junction; Laparoscopic resection.

Fig. 1

Upper endoscopy showed a 60-mm submucosal tumor with mucosal ulceration on the top. The tumor extended from the lower esophagus to the upper gastric corpus

Fig. 2

a Preoperative computed tomography showed the cystic tumor attached to the anterior wall of the esophagus and EGJ. b T2-weighted magnetic resonance imaging (coronal view) showed a high-intensity mass between the liver and stomach

Fig. 3

a The tumor was attached to the EGJ. b Full-thickness dissection was performed (E esophagus, S stomach). c The defect on the EGJ was closed by hand sewing. The esophageal side was closed vertically with interrupted sutures. The gastric side was closed horizontally by a running suture. Toupet fundoplication was added

Fig. 4

Schemas of the operative procedures. a After resection of the tumor, b the stomach defect was closed by a continuous suture, c the esophageal defect was closed by interrupted sutures, and Toupet fundoplication was added

Fig. 5

Pathological findings. a, b The surface of the tumor was covered with the mucosal layer of the esophagus and stomach in continuity with their muscular layer. c The intraluminal surface of the tumor was lined with columnar ciliated epithelium (hematoxylin and eosin staining)

Fig. 6

Postoperative esophagography using Gastrografin, which revealed no reflux in a head-down-tilted position

Fig. 7

Endoscopic evaluation 3 months postoperatively showed no stenosis, deformation of the cardia, or reflux