Tubular Oesophageal Duplication: A Difficult Truth to Swallow in a Child with Stunted Growth, Unravelling with Imaging

Congenital oesophageal duplications are rare anomalies classified under foregut malformations. They represent approximately 20% of all gastrointestinal (GI) duplications, which occur in about 1 in 4,500 live births. Among GI duplications, ileal duplications are the most common, while oesophageal duplications are relatively uncommon, and occur with equal frequency in males and females. The clinical presentation depends on the size and location of the duplication. Many children exhibit non-specific symptoms such as poor weight gain, stunted growth, feeding difficulties, dysphagia, or respiratory issues due to compression of adjacent structures. Early diagnosis through imaging and appropriate surgical management is crucial to prevent complications. We report the case of a 5-year-old male child weighing 10 kg who presented with stunted growth and progressively worsening dysphagia, more pronounced for solids than liquids, over four years. Imaging findings from thin barium swallow demonstrated a dilated upper oesophagus with stricture at the junction of the upper and mid oesophagus, along with a large hiatal hernia causing upward displacement of the gastro-oesophageal junction and narrowing at this level in the upright position; in the supine position, the paraoesophageal contrast extended up to C5, while the duodenal and proximal bowel loops appeared normal. Contrast-enhanced computed tomography (CT) of the neck, chest, and upper abdomen revealed partial duplication of the proximal and mid oesophagus, with a midline fold or membrane extending approximately 6 cm from C5 to D7, in addition to a dilated lower oesophagus. Cross-functional imaging enabled a non-invasive diagnosis of this rare anomaly and provided crucial anatomical details for planning surgical correction, highlighting the potential for definitive treatment with minimal mediastinal complications.