P1.054. A Surgical Approach towards an Upper Thoracic Esophageal Duplication Cyst in a Young Adult

Topic Benign Disease: Pediatric Esophageal Disorders Case Submission Upper Esophageal duplication cysts are rare. Approximate prevalence of Gastrointestinal duplication cyst is in 1 in every 4000 to 5000 live births, only 17 – 20% of gastrointestinal duplication cyst occurs in the esophagus where two thirds of them is located at the lower esophagus. Uncomplicated thoracic esophageal duplication cyst is often found incidentally. However, complications of the lesion including compression symptoms, infection and malignant change may be life threatening. Several strategies can be employed upon the diagnosis of an asymptomatic esophageal duplication cyst including watchful waiting, endoscopic drainage and surgical excision. In this case presented, we advocated a definitive intervention even though the patient is asymptomatic as the patient is only 18 years old and already has features of aerodigestive compression on the computerized tomography scan. We did not consider endoscopic drainage as that may carry a risk of complications in the long run for this young man like bleeding, food retention and infection of a retained sinus. Intraoperatively, only a small fraction of the cyst remains adhered to the esophageal wall (less than 1 centimeter). Weighing the risk of esophageal myotomy, the risk of stricture and diverticulum with the risk of recurrence and subsequent malignant change, a small cuff of cyst wall was left behind and the patient was advised post operatively for timely follow up. This can be achieved in our local setting as the healthcare infrastructure in Malaysia provides the accessibility for patients to acquire timely follow ups for early detection of recurrence or malignant change.