POST MEDIASTINAL GASTROENTERIC CYST: A CASE
REPORT
(i) Al
Ajmi Mona,
(ii) Al Othman Najeeb, (iii) Adel Al Khider
(i), (ii) Al
Sabah Hospital, PICU, Kuwait(iii) Chest Hospital, Thoracic Surgery Dept.,
Kuwait
Introduction:
Gastro-enteric
cyst which is reduplication cysts of the foregut have been rarely reported
it is comprised only 0-4% of all post mediastinal masses.
Case
Report: N.F is a 4 1/2 months old infant, a product of full term normal
delivery with uneventful pregnancy, birth weight is 3 kg, started to have
difficulty in breathing, bouts of coughing with tachypnoea and hoarseness
at one month of age. He was admitted many times for this problem. On 14th
of October 2000 he represent with severe respiratory distress and cyanosis
not responding to the ordinary supportive measures given in the casualty.
Patient transferred to PICU where he was incubated and connected to
mechanical ventilator. Investigation revealed CxR: shifting of trachea to
the right side with upper right lobe consolidation,.Barium swallow showed:
Right lateral displacement of oesophagus at upper thoracic level. CT chest
showed: Mid mediastinal cyst size 3.5x2x1.9 cm at level TH 1-4-5 with
enhancing capsule, dislocate trachea and eosophagal to right,
mal-segmentation vertebrae C7-TH 1-2 after chest surgeon consultation.
Total excision of the cyst had been done following lt throachotomy and
exploration, histopathology examination section of the cyst show alining
which varies gastric mucosa with partial cells and squamous epithelia, submucosa
at part lined by gastric mucosa. This feature goes with dorsal
gastro-enteric cyst. Patient had uneventful postoperative period on follow
up examination after 6 months of surgery found to be completely
asymptomatic.
Discussion: Enterogenous cysts are thought to be
arise from the dorsal foregut "destined" to become the alimentary
tract . It has been postulated that they are intrathoracic vestiges of the
ductus omphalomesentricus that they arise from sequestrations of nodules of
foregut in the developing embryo. The most congent theory that Fallon et al
and Veeneklass is that the entrodermal tube adheres Focally to the
notocord, with development of
embryo a "traction diverticulum" forms, which later separates to
form gastroenteric cyst. This
theory giving constant relationship of these cysts to vertebrae and high
incidence associated vertebral multiformation. The intravertebral extension
of the foregut can disrupt vertebral body development induce a sagittal
cleft defect or more vertebral anomalis. 50% of enterogenous cyst are
associated with cervical and thoroaic vertebral anomalies such as scoliosis
are anterior spina bifida, hemivertebrae, Two-thirds of patients eventually
develop symptoms most commonly airway or eosophagal obstruction ,infants
and children commonly present with symptoms of severe airway obstruction or
pneumonia .The prefered treatment is complete excision of the cyst. The
prognosis is following complete excision is excellent.