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Respiratory obstruction caused by lipoma of the esophagus
Respiratory
Obstruction
Caused by Lipoma of the Esophagus
ByNizamul
Hasan
and Parkash
Mandhan
Karachi, Pakistan l A four-year-old boy presented with wheezing of 5 months‘ duration after a cold. During examination, an opacity was noted in the superior mediastinum, causing displacement of the trachea to the right. A barium swallow showed a mass in the wall of the esophagus, occupying the lumen, without causing any obstruction. Through further examination by computed tomography and magnetic resonance imaging, the mass was confirmed to be a lipoma in the wall of esophagus, causing displacement of trachea. The mass was removed via the transcewical approach, and the postoperative course was uneventful. Respiratory obstruction caused by a lipoma of esophagus in childhood had not been reported in the English language literature. Copyright o 1994 by W.B. Saunders Company INDEX WORDS: Esophageal lipoma, obstruction, esophageal lipoma.
pediatric;
respiratory
T
UMORS OF THE esophagus are rare in childhood. By virtue of their size, benign tumors can be life-threatening, specially if confined to a narrow space in relation to a vital structure. We present a case of lipoma of the esophagus, which was situated in the superior mediastinum and caused pressure on the trachea. CASE
REPORT
A 4-year-old boy had wheezing of 5 months’ duration after a cold. Upon presentation he appeared anxious, and the wheezing was audible from a distance. His neck veins were prominent, and the upper sternum was bulging. The cervical and axillary lymph nodes were not palpable. An chest x-ray showed a mass in the Fig 2. MRI delineating the mass in the superior displacing the trachea anteriorly.
mediastinum,
superior mediastinum, which displaced the trachea to the right. A barium swallow showed that the tumor protruded into the lumen of the thoracic esophagus, not causing any obstruction (Fig 1). Through further examination by computed tomqgraphy and magnetic resonance imaging (Fig 2). the tumor size was noted to be 5 x 4 x 2 cm; it was situated in the wall of esophagus and displaced the trachea to the right. Through a skin crease incision 1 cm above the sternum and more toward the left side, the skin and platysma flaps were lifted separately. The fascia was divided in the midline vertically. The strap muscles and strenocledomastoid muscles were reflected toward the left. The tumor was identified and was manipulated from the superior mediastinum into the cervical wound. The
Fig 1. Barium swallow showing esophageal trachea to the right side.
JournalofPediafricSufgery.
Vol29, No 12
lipoma shifting the
(December),
1994: pp 1566-1666
From the Orthopedic and Medical Institute, Karachi, Pakistan. Address reprint requests to Professor Ntiamul Hassan, 54 10th St. Phase V, Defense Housing Society. Karachi 75500. Pakistan. Copyright Q 1994 by WB. Saunders Cornpay 0022-346819412912-0020$03.00l0
1565
1566
HASAN AND MANDHAN
begun through the tube. The sutures and feeding tube were removed on the fifth postoperative day, and patient was discharged the following day. Through histological examination, the diagnosis of benign lipoma was confirmed. DISCUSSION
Tumors of the esophagus are rare in childhood. Lipoma can occur in any part of the alimentary tract, and its overall incidence is 4.1%; that of esophageal lipoma is 0.4%. l Commonly, esophageal lipoma presents with dysphagia. In adults, most esophageal lipomas are pedunculated and located in the cervical esophagus. In one case, the tumor was in the wall of thoracic esophagus and was removed through thoracotomy.2 The pedunculated type may regurgitate and cause death by suffocation.3 In a review of the English language literature, we found no other childhood case of lipoma of the esophagus. The present case is unusual because it presented with respiratory obstruction. ACKNOWLEDGMENT
Fig 3.
Gross appearance of the tumor.
longitudinal muscle fibers of the esophagus were hypertrophied. The muscles over the tumor were incised vertically. The lobulated tumor was easily dissected free from the muscles (Fig 3). While the tumor was freed from the mucous membrane, a rent was made inadvertently. This was closed by 3-O Vicryl sutures (Ethicon Ltd, Edinburgh, Scotland). The muscles also were approximated with 3-O Vicryl. A drain was left in the superior mediastinum, and the wound was closed in layers. A nasogastric tube was retained for feeding. The drain was removed after 24 hours, and feeding was
The authors acknowledge the Orthopaedic tute Karachi for secretarial assistance.
and Medical Insti-
REFERENCES 1. Mayo CW, Pagutulunan PJG, Brown DJ: Lipoma of alimentary tract. Surgery 53593-603, 1963 2. Akiyama S, Katoora M, Horisawa M, et al: Lipoma of oesophagus-Report of a case and review of literature. Jpn J Surg 20:458-462,199O 3. Allen MS Jr, Charlottesville Va, Talbot WH: Sudden death due to regurgitation of a pedunculated oesophageal lipoma. J Thorac Cardiovasc Surg 54:756-758,1967
Obstruction
Caused by Lipoma of the Esophagus
ByNizamul
Hasan
and Parkash
Mandhan
Karachi, Pakistan l A four-year-old boy presented with wheezing of 5 months‘ duration after a cold. During examination, an opacity was noted in the superior mediastinum, causing displacement of the trachea to the right. A barium swallow showed a mass in the wall of the esophagus, occupying the lumen, without causing any obstruction. Through further examination by computed tomography and magnetic resonance imaging, the mass was confirmed to be a lipoma in the wall of esophagus, causing displacement of trachea. The mass was removed via the transcewical approach, and the postoperative course was uneventful. Respiratory obstruction caused by a lipoma of esophagus in childhood had not been reported in the English language literature. Copyright o 1994 by W.B. Saunders Company INDEX WORDS: Esophageal lipoma, obstruction, esophageal lipoma.
pediatric;
respiratory
T
UMORS OF THE esophagus are rare in childhood. By virtue of their size, benign tumors can be life-threatening, specially if confined to a narrow space in relation to a vital structure. We present a case of lipoma of the esophagus, which was situated in the superior mediastinum and caused pressure on the trachea. CASE
REPORT
A 4-year-old boy had wheezing of 5 months’ duration after a cold. Upon presentation he appeared anxious, and the wheezing was audible from a distance. His neck veins were prominent, and the upper sternum was bulging. The cervical and axillary lymph nodes were not palpable. An chest x-ray showed a mass in the Fig 2. MRI delineating the mass in the superior displacing the trachea anteriorly.
mediastinum,
superior mediastinum, which displaced the trachea to the right. A barium swallow showed that the tumor protruded into the lumen of the thoracic esophagus, not causing any obstruction (Fig 1). Through further examination by computed tomqgraphy and magnetic resonance imaging (Fig 2). the tumor size was noted to be 5 x 4 x 2 cm; it was situated in the wall of esophagus and displaced the trachea to the right. Through a skin crease incision 1 cm above the sternum and more toward the left side, the skin and platysma flaps were lifted separately. The fascia was divided in the midline vertically. The strap muscles and strenocledomastoid muscles were reflected toward the left. The tumor was identified and was manipulated from the superior mediastinum into the cervical wound. The
Fig 1. Barium swallow showing esophageal trachea to the right side.
JournalofPediafricSufgery.
Vol29, No 12
lipoma shifting the
(December),
1994: pp 1566-1666
From the Orthopedic and Medical Institute, Karachi, Pakistan. Address reprint requests to Professor Ntiamul Hassan, 54 10th St. Phase V, Defense Housing Society. Karachi 75500. Pakistan. Copyright Q 1994 by WB. Saunders Cornpay 0022-346819412912-0020$03.00l0
1565
1566
HASAN AND MANDHAN
begun through the tube. The sutures and feeding tube were removed on the fifth postoperative day, and patient was discharged the following day. Through histological examination, the diagnosis of benign lipoma was confirmed. DISCUSSION
Tumors of the esophagus are rare in childhood. Lipoma can occur in any part of the alimentary tract, and its overall incidence is 4.1%; that of esophageal lipoma is 0.4%. l Commonly, esophageal lipoma presents with dysphagia. In adults, most esophageal lipomas are pedunculated and located in the cervical esophagus. In one case, the tumor was in the wall of thoracic esophagus and was removed through thoracotomy.2 The pedunculated type may regurgitate and cause death by suffocation.3 In a review of the English language literature, we found no other childhood case of lipoma of the esophagus. The present case is unusual because it presented with respiratory obstruction. ACKNOWLEDGMENT
Fig 3.
Gross appearance of the tumor.
longitudinal muscle fibers of the esophagus were hypertrophied. The muscles over the tumor were incised vertically. The lobulated tumor was easily dissected free from the muscles (Fig 3). While the tumor was freed from the mucous membrane, a rent was made inadvertently. This was closed by 3-O Vicryl sutures (Ethicon Ltd, Edinburgh, Scotland). The muscles also were approximated with 3-O Vicryl. A drain was left in the superior mediastinum, and the wound was closed in layers. A nasogastric tube was retained for feeding. The drain was removed after 24 hours, and feeding was
The authors acknowledge the Orthopaedic tute Karachi for secretarial assistance.
and Medical Insti-
REFERENCES 1. Mayo CW, Pagutulunan PJG, Brown DJ: Lipoma of alimentary tract. Surgery 53593-603, 1963 2. Akiyama S, Katoora M, Horisawa M, et al: Lipoma of oesophagus-Report of a case and review of literature. Jpn J Surg 20:458-462,199O 3. Allen MS Jr, Charlottesville Va, Talbot WH: Sudden death due to regurgitation of a pedunculated oesophageal lipoma. J Thorac Cardiovasc Surg 54:756-758,1967