BRONCHOGENIC CYSTS AND ESOPHAGEAL DUPLICATIONS - COMMON ORIGINS AND TREATMENT

Background/Purpose: Bronchogenic cysts and esophageal duplications are usually considered as separate foregut malformations. Yet, both are t hought to arise from the same embryological event, division of the emb ryonic foregut, and they share common histological characteristics, of ten making their clinical differentiation difficult. Methods: A retros pective review of the cases of 68 children treated at a single institu tion between 1937 and 1995 was performed. Thirty children were girls ( 44%) and 38 were boys (56%). Ages ranged from newborn to 24 years. Com plete records were available in all children. Fourteen of these 68 chi ldren were asymptomatic. Results: Respiratory (54%) or gastrointestina l (13%) symptoms were the most frequent presenting problems. The major ity of children were treated by resection of the cyst (52 of 68; 76%), while 9 of 68 (13%) required lobectomy for intraparenchymal lesions. Three children underwent marsupialization, with all of these children requiring additional surgery for recurrent disease. Five children (5 o f 68; 7%) had multiple cysts. The mortality rate from this series was 10% (7 of 68). Two deaths were caused by perioperative exsanguination, one related to bleeding from a cyst lined with gastric mucosa with su bsequent ulceration and hemorrhage into the esophagus. Two deaths occu rred secondary to septic complications, one from an esophageal leak an d the other from an intraparenchymal abscess. Two deaths were caused b y respiratory failure; one was unrelated (SIDS). The majority of cysts found on histological review were lined by respiratory epithelium or bronchial glands (51 of 68; 75%). Gastrointestinal epithelium was pres ent in cysts of nine children, only two of which were clinically diagn osed as esophageal duplications. Twenty-one cases (21 of 68; 31%) were classified as esophageal duplications based on the intramural locatio n of the cyst, yet 15 of 21 (71%) contained respiratory epithelium, su bstantiating the hypothesis of the common origin of these lesions. Con clusions:The histological similarity and anatomic proximity of the ''b ronchogenic cysts'' and the intramural ''esophageal duplications'' sup ports their common origin, The possible complications of bleeding, ulc eration, infection, and obstruction of the esophagus or airway, should generally lead to prompt resection. Copyright (C) 1997 by W.B. Saunde rs Company.