Esophageal mucoceles causing airway obstruction as a complication of esophageal diversion: two rare pediatric cases and a review of the literature.

An esophageal mucocele causing airway obstruction is an exceptionally rare complication of esophageal diversion in children. In this instance, they are fluid-filled dilatations of the esophageal remnant following bipolar exclusion of the thoracic esophagus. Only six pediatric cases have been reported previously in the literature. We present two consecutive cases of esophageal mucoceles causing respiratory distress in children following surgical exclusion of the esophagus. Bronchoscopy followed by imaging (computerized tomography or magnetic resonance imaging) was used to reach the diagnosis. Complete resection of the thoracic esophagus was required in both patients. Esophageal mucoceles can occur many years after esophageal exclusion, and the clinical features are often non-specific. Furthermore, complex co-morbidities may mask the underlying etiology of the respiratory distress, thus the diagnosis may be difficult to delineate. A high degree of suspicion, clinical awareness, and the use of the proper diagnostic tools, are essential for a diagnosis of mucoceles in children with a past history of esophageal exclusion.

Symptomatic mucocele after esophageal exclusion.

Surgical exclusion of the thoracic esophagus can result in the accumulation of secretions and dilatation of the esophageal remnant, a clinical picture known as esophageal mucocele. Although it is usually asymptomatic, if it increases in size it can produce a variety of compressive symptoms such as coughing, chest pain and respiratory distress. We present two cases of symptomatic mucocele after esophageal exclusion treated successfully with surgical resection. We believe that surgical resection should be considered for symptomatic patients, and that esophageal bypass surgery should be used with caution and indicated mostly in patients with a limited life span or with contraindications for esophagectomy.

[6 para-esophageal cysts. Discussion on their origins]. / A propos de six kystes para-oesophagiens. Discussion sur leurs origines.

Para-oesophageal cyst is a rare lesion which can be classified, by its origin, as a gastrointestinal duplication. It is mostly encountered in children. Since 1977, we have observed 6 cases in adults, and 5 out of 6 presented as postero-inferior mediastinal tumors. Pre-operative diagnosis is difficult: when the lesion is intramural, the only other diagnosis is leiomyoma; in other cases, a bronchogenic cyst or a posterior mediastinal enteric formation can be discussed. Surgical findings and histological criteria allow a precise definition of these cysts, which lie at least partially in the wall of the oesophagus. There was a histological association of respiratory mucosa and musculosa, either of type or associated with cartilaginous islets. The definition of the clinical classification is easier with a good knowledge of the histogenesis.

Duplication of the cervical esophagus. An unrecognized cause of respiratory distress in infants.

Infants with respiratory distress demand prompt action and thorough evaluation for possible causes. An urgent but infrequent source of upper airway obstruction is a duplication cyst of the cervical esophagus. Standard references omit this diagnosis in the consideration of both respiratory distress and neck masses in infants. Two patients were admitted with respiratory distress and delayed recognition of a neck mass. Contrast and sonographic studies revealed a cystic mass displacing the trachea in each case. Careful excision promptly relieved symptoms, and histopathologic evaluation confirmed the diagnosis. Duplication of the esophagus can compromise the normal airway, thereby presenting with respiratory difficulty prior to recognition of a neck mass. X-ray studies demonstrating displacement of the trachea or esophagus due to a soft-tissue mass and documentation of a cyst by ultrasound will aid in establishing the diagnosis. Surgical principles include aspiration and excision of the mucosal lining, with preservation of the muscular coat and mucosal septum. Duplication of the cervical esophagus should be considered in the differential diagnosis of both respiratory distress and an enlarging neck mass in infants.