Intra-abdominal pulmonary secuestration as an exceptional cause of abdominal mass in the adult

INTRODUCTION: Pulmonary sequestration (PS) is an extremely rare malformation defined as a portion of lung tissue isolated from the pulmonary system. PSs are classified into intralobar type and intraabdominal PS that represents only 2.5% of cases. There are 20 cases of PS reported in adults and only two were managed by laparoscopic approach. We report a case of intra-abdominal PS mimicking a gastroesophageal duplication cyst in an adult. Besides its rarity, this is the first intra-abdominal PS in an adult managed by an anterior laparoscopic approach. PRESENTATION OF CASE: A 60-year-old female patient had had epigastric and left upper quadrant pain for several days. Physical examination was normal. Image test were consistent with a gastroesophageal duplication. The patient was taken to the operating room for laparoscopic exploration and resection. The pathological diagnosis was extralobar pulmonary sequestration. DISCUSSION: Less than 20 cases of PS have been reported in adults and only two cases were managed by a lateral laparoscopic approach. In contrast to these reports, we used an anterior approach due to the GEJ suspected origin of the mass. CONCLUSION: Extralobar intra-abdominal PS is an extremely rare condition during adulthood but this diagnosis should be included in the differential diagnosis of a left-sided suprarenal mass. Due to the difficulty in achieving a definitive preoperative diagnosis, surgery is recommended. Laparoscopic resection reful blish is safe and effective but ca suitable approach. © 2013 The Authors. Pu A 60-year-old female patient had had epigastric and left upper uadrant pain for several days. Her medical history was irrelevant. hysical examination was normal. Abdominal ultrasound revealed left suprarenal mass. Computed tomography showed a 7 × 4 cm ystic soft tissue mass with internal calcification just above the eft adrenal gland and beneath the diaphragm (Fig. 1). Biochemcal testing was performed and showed normal plasma levels of drenocortical hormones and catecholamines. Abdominal magetic resonance imaging showed a 7.5 × 6 × 4 cm cystic mass ossibly arising from the gastroesophageal junction (GEJ) and adjaent to but independent from the adrenal gland, spleen, pancreas nd stomach. Vascularization was not detected (Fig. 2). Although o other diagnosis could be excluded, gastroesophageal duplicaion was suggested. This diagnosis was also suggested by an upper This is an open-access article distributed under the terms of the Creative Comons Attribution-NonCommercial-No Derivative Works License, which permits on-commercial use, distribution, and reproduction in any medium, provided the riginal author and source are credited. ∗ Corresponding author at: Department of Surgery, La Mancha Centro General ospital, Avenida de la Constitucion s/n, 13600 Alcazar de San Juan, Ciudad Real, pain. Tel.: +34 926 580 688; fax: +34 926 580 688. E-mail address: cmsurgery@hotmail.com (C. Moreno-Sanz). 210-2612/$ – see front matter © 2013 The Authors. Published by Elsevier Ltd on behalf o ttp://dx.doi.org/10.1016/j.ijscr.2013.08.019 preoperative imaging studies are recommended in order to plan the most ed by Elsevier Ltd on behalf of Surgical Associates Ltd. All rights reserved. endoscopic ultrasound that revealed a 7 cm cystic mass arising from the posterior wall of the GEJ. After discussing the diagnosis, benefits, risk and alternatives with the patient, she was taken to the operating room for laparoscopic exploration and resection. The laparoscopic procedure was performed in the supine decubitus position. A Hasson trocar was placed in the umbilicus. Under direct vision, a 12 mm trocar was placed in the left upper quadrant and 5 mm trocars were placed in the right quadrant, left subcostal margin and epigastrium. Upon inspection of the abdomen no obvious lesions were found. After gastrosplenic and short vessels freed, the mass was evident. Using the ultrasonic coagulating shears the lesion was dissected from the spleen, pancreas, left diaphragm, left crus, abdominal aorta and gastric posterior wall. The GEJ was dissected and isolated completely. The mass was attached to the posterior aspect of the GEJ and the resection was completed by stapling this tissue. The pathological diagnosis was extralobar pulmonary sequestration.