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Han, Kim, Lee, Lee, I, and Kim: A Case of Hemorrhage of an Esophageal Duplication Cyst Improved by Endoscopic Drainage
Case Report

The Korean Journal of Gastroenterology 2017; 69(6): 363-367.

Published online: 23 June 2017

DOI: https://doi.org/10.4166/kjg.2017.69.6.363

A Case of Hemorrhage of an Esophageal Duplication Cyst Improved by Endoscopic Drainage

In Sub Han, Gwang Ha Kim, Seong Jun Lee, Bong Eun Lee, Hoseok I1, Yeong Dae Kim1

Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.

1Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Busan, Korea.

Correspondence to: Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: +82-51-240-7869, Fax: +82-51-244-8180, doc0224@pusan.ac.kr

Received 20 March 2017       Revised 6 May 2017       Accepted 12 May 2017

Copyright © 2017. Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Esophageal duplication cyst is a rare congenital gastrointestinal malformation. It is the second most common duplication cyst following small bowel duplication cyst in the gastrointestinal tract. Patients with an esophageal duplication cyst are generally asymptomatic; however, some patients may present the following symptoms: dysphagia, chest pain, stridor, unproductive cough, and epigastric discomfort by compression of the surrounding structures. Surgical removal is the treatment of choice in symptomatic cases and can be considered in asymptomatic cases if they are at risk for developing complications, such as ulceration or perforation. Herein, we report a case of hemorrhage of an esophageal duplication cyst, which was improved by endoscopic drainage.

Keywords: Esophagus, Cyst, Endoscopic ultrasonography, Drainage

Figures and Tables

Fig. 1

Chest computed tomography (CT). (A) Initial chest CT. A large cystic mass with inner high density suggesting hematoma is observed at the posterior mediastinum, and this mass compresses the lower esophagus. (B) Follow-up chest CT after operation. Previous cystic mass is still observed, but with slightly reduced size.

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Fig. 2

Emergent intra-operative thoracoscopy. (A) Mediastinum is clear, and the external surface of the esophagus is intact. However, the esophagus is markedly swollen. (B) After incision of the esophagus, a large amount of hematoma is found in the esophageal wall, but the esophageal muscular, submucosal, and mucosal layers are intact.

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Fig. 3

Endoscopic drainage. (A) A subepithelial lesion with positive cushion sign (arrow) is observed at the lower esophagus. (B) On endoscopic ultrasonography, the lesion is a 7.6 cm-sized cystic lesion located at the muscular layer of the esophagus, and a large amount of hyperechoic floating materials are observed inside the cystic lesion. (C) Mucosal and submucosal incision is performed using a dual knife. (D) A large amount of hematoma and pus are found inside the lesion. These hematoma and pus are removed via repetitive endoscopic aspiration and saline washing.

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Fig. 4

Follow-up endoscopy and endoscopic ultrasonography (EUS) at 4 months after endoscopic drainage. (A) On endoscopy, the previous subepithelial lesion is markedly decreased, and the incision site is completely healed (arrow). (B) On EUS, the cystic lesion is still observed at the muscular layer of the esophagus, but its size decreases to 3.7 cm and the previous hyperchoic floating materials are not seen any more.

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Notes

Financial support None.

Conflict of interest None.

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