Long-gap esophageal atresia associated with foregut duplication – a case report and literature review

Coexisting long-gap esophageal atresia (EA) with a mediastinal duplication cyst is rare and difficult to diagnose. A 12-month-old boy, after multistage long-gap EA repair, presented with recurrent airway infections and a large mediastinal cystic lesion on computed tomography scans. Esophageal atresia repair was performed during infancy, with no coexisting pathology reported intraoperatively. Open Nissen fundoplication with gastrostomy and pyloroplasty was performed due to refractory gastroesophageal reflux. Recurrent airway infections were observed after an asymptomatic period. Thoracoscopic removal of the foregut duplication cyst was performed. At the 8-month follow-up, no recurrence of symptoms was reported. The coexistence of a foregut duplication cyst and EA is very rare, and diagnosis is challenging. Only 14 cases have been reported in the available literature. We recommend considering the possible association of EA and congenital foregut cyst intraoperatively, especially in symptomatic patients.