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A 37-year-old (G4P3) woman was referred to our hospital at 32 weeks of gestation for the evaluation of a fetus with an intrathoracic cystic lesion. Ultrasonography and magnetic resonance imaging revealed that a fetal cystic lesion without a mucosal layer was located in the posterior mediastinum. These findings were consistent with a bronchogenic cyst. At 38 3/7 weeks of gestation, an elective cesarean section was performed because of her previous cesarean section. A female neonate without any external anomalies, weighing 2,442 g, with Apgar scores of 8 and 9, and requiring no resuscitation was born. Four weeks after delivery, the neonate was admitted because of respiratory distress due to mass effect. At right lateral thoracotomy, a 105 × 65 mm of solitary smooth-walled cyst containing serosanguineous fluid was found in the posterior mediastinum, which was excised completely. Histologic examination revealed the diagnosis of the mediastinal gastric duplication cyst. The neonate made an uneventful recovery. Accurate diagnosis is not necessary, but detection and continuous observation are logical. Although gastric duplication, particularly intrathoracic, is a rare pathology, it should be considered in the differential diagnosis of any intrathoracic cyst.

A 27-month-old girl with type C esophageal atresia underwent primary anastomosis after birth. Her gestational age was 38 weeks 2 days and weight at birth was 2538 g. At the age of 16 months, she experienced vomiting after consuming solid food. Esophagography indicated absence of stenosis at the anastomotic site; however, tapered narrowing of the lower esophagus was detected. A constriction at the esophagus was detected when the patient underwent endoscopic balloon dilatation for esophageal stenosis twice at the ages of 21 and 25 months. Therefore, a diagnosis of congenital esophageal stenosis due to aberrant tracheobronchial remnants was made. At the age of 27 months, the esophagus along with the constriction was resected via left thoracotomy. Pathological examination of the resected specimen indicated fibromuscular thickness in the stenotic lesion. Thereafter, the patient was discharged and her clinical course was uneventful. Two months after the surgery, esophageal stenosis was found to be absent on esophagography. Previous case reports have frequently attributed congenital esophageal stenosis associated with esophageal atresia to aberrant tracheobronchial remnants, necessitating partial resection of the stenosis. Here, we report the case of a patient with congenital esophageal stenosis due to fibromuscular thickness, successfully treated by partial resection of the stenosis.

The case of a large nonparasitic liver cyst with a 9-year history of cyst recurrence after undergoing aspiration therapy in a 78-year-old woman is herein reported. Nine years prior to this admission, she underwent an operation for a hernia of the lumbar intervertebral disc. At operation, a large liver cyst was incidentally detected, and the cyst was aspirated at that time to relieve her abdominal pain. Five years after the initial therapy, she developed abdominal distension and pain. The patient again underwent cyst aspiration. Thereafter, she experienced a 4-year symptom-free period after the second cyst aspiration. On admission, an abdominal CT scan revealed a large simple cyst measuring 17×12×17 cm in size which occupied most of the right liver lobe extending down to the right lower quadrant. At laparotomy, a large cyst showed entensive fibrous adhesions to the adjacent viscera. Following lysis of adhesions and the evacuation of the cyst fluid, the cyst, which was bulging into the abdominal cavity, was almost totally excised (unroofing). She remained asymptomatic 5 months after discharge. The standard treatment for nonparasitic liver cysts currently consists of cyst aspiration and alcohol sclerotherapy. However, the long-term follow-up of cysts after aspiration is unknown. Therefore, at present, cyst recurrence after aspiration may require either cyst unroofing or a partial excision., 論文

A 27-month-old girl with type C esophageal atresia underwent primary anastomosis after birth. Her gestational age was 38 weeks 2 days and weight at birth was 2538 g. At the age of 16 months, she experienced vomiting after consuming solid food. Esophagography indicated absence of stenosis at the anastomotic site; however, tapered narrowing of the lower esophagus was detected. A constriction at the esophagus was detected when the patient underwent endoscopic balloon dilatation for esophageal stenosis twice at the ages of 21 and 25 months. Therefore, a diagnosis of congenital esophageal stenosis due to aberrant tracheobronchial remnants was made. At the age of 27 months, the esophagus along with the constriction was resected via left thoracotomy. Pathological examination of the resected specimen indicated fibromuscular thickness in the stenotic lesion. Thereafter, the patient was discharged and her clinical course was uneventful. Two months after the surgery, esophageal stenosis was found to be absent on esophagography. Previous case reports have frequently attributed congenital esophageal stenosis associated with esophageal atresia to aberrant tracheobronchial remnants, necessitating partial resection of the stenosis. Here, we report the case of a patient with congenital esophageal stenosis due to fibromuscular thickness, successfully treated by partial resection of the stenosis., 論文