Endoscopic Mangement of a Tubular Esophageal Duplication Diagnosed in a 14 Year Old Male
Comments: We report the case of a 14-year-old male with a medical history of two episodes of epigastric pain at the age of 6 and 9 years that were relieved with PPI's administration. He also had to make permanent changes in his eating habits such as avoiding meat. He presented with acute dysphagia to solids and liquids and acute retrosternal pain.
On barium oesophagogram, double-lumen esophagus was seen and cystic oesophageal duplication was suspected.
On CT scan the double lumen oesophagus was confirmed.
During the upper GI endoscopy, the scope couldn't be pushed further because of a stenosis of the cervical oesophagus. Following this a laparoscopic gastrostomy was performed.
During second endoscopy, the patient underwent balloon dialation. A double oesophageal lumen starting at 20 cm from the incisors was seen. However, further scope advancement was still impossible.
An oesophageal cyst excision through right thoracoscopy was then considered with upper GI endoscopy assistance. The oesophageal was isolated. No extraluminal cystic duplication was seen and the procedure was abandoned. The absence of cystic duplication suggested a tubular type is partial open oesophagectomy, it was decided to discuss less invasive alternatives.
One month later, a repeat barium oesophagogram demonstrated the tubular type of the duplication and the patient was referred to our Endoscopy Center for further treatment. The patient resumed food intake. He had to avoid solid food though, and no aggravation in his symptoms was reported symptom.
Under general anesthesia a standard endoscope was inserted until 25 cm from the incisor teeth because of a fibrotic stenosis starting at 15cm. Two oesophageal lumens were seen at 35 cm. A pediatric endoscope with an outer diameter of 5.9 mm was then advanced through the main lumen of the oesophagus into the stomach. A thick bridge extending from 26 to 31 cm separated the 2 oesophageal lumens. A depressed area extending from 24 to 35 cm was seen above and below the ends of the narrow lumen. The scope passage into the narrow lumen was possible after the insertion of a guide wire, revealing that its distal end was in communication with the oesophagus. The diagnosis of total tubular oesophageal duplication was endoscopically confirmed. Using a needle knife, the longitudinal incision of the intraluminal bridge was successfully performed, starting from the upper to its distal end. The passage of a standard endoscope into the stomach showed the internal fixation system of the previously placed gastrostomy tube. The procedure was completed with biopsies and stricture dilation. Oral food intake was resumed on the same day. The patient outcome was uneventful and he was discharged within 24 hours.
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Dimitri Coumaros, MD University Louis Pasteur, Strasbourg, France |
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Citation: Coumaros, D. (Jun 01 2009). Endoscopic Mangement of a Tubular Esophageal Duplication Diagnosed in a 14 Year Old Male. The DAVE Project. Retrieved Sep, 8, 2010, from http://daveproject.org/viewfilms.cfm?film_id=869 Times viewed since Feb 2006: 1632 |
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