Laparoscopic excision of intra-abdominal oesophageal duplication cyst in a child
A 13-year-old girl presented with c/o pain abdomen since 2 days. H/o vomiting 3 episodes and high degree fever. No previous significant history. O/E her vitals were stable. P/A there was tenderness in epigastric region, rest of the abdomen was soft. There was no guarding/rigidity. Bowel sounds and other systems were normal.\nHer blood investigations were normal except for slight leucocytosis. Ultrasonography of abdomen showed a cystic lesion in the upper abdomen adjacent to left lobe of liver. Computerized tomography scan of the abdomen and magnetic resonance imaging of abdomen narrowed the differential diagnosis to a cystic lesion at the gastro-oesophageal junction adjacent to left lobe of liver measuring 4 × 5 cm in size. Clinical diagnosis of foregut duplication cyst was made.\nDiagnostic laparoscopy and excision of the cyst was planned. A 10 mm umbilical port for camera and two 5 mm working ports on either side with an additional port for liver retraction were used. []\nA cystic lesion at gastro-oesophageal junction below the left lobe of liver was identified. The cyst was adherent to oesophagus []. With help of harmonic scalpel, cyst was dissected from surrounding structures. Subtotal excision of cyst wall was done except the part that was adherent to oesophagus. Mucosal layer of the cyst wall adherent to the oesophagus was excised []. Intactness of oesophageal mucosa was confirmed by injecting air through nasogastric tube positioned at lower end of oesophagus. Drain was inserted from right sub costal port site, which was removed after 48 hours. Child had uneventful post operative recovery and discharged from hospital on 6th postoperative day. Histopathology confirmed the presence of muscle layer and lined by gastric mucosa.