Eastern Cardiothoracic Surgical Society

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Case of recurrent esophageal leiomyoma after esophagectomy.
Shawn P. Robinson, Rece Laney, Ikenna Okereke.
UTMB Galveston, Galveston, TX, USA.

OBJECTIVE: The objective of this study was to examine the various approaches to surgical resection of a recurrent esophageal leiomyoma.
METHODS: We present a case of a 36-year-old female presenting with dysphagia (solids worse than liquids) and significant unintentional weight loss. She had undergone an open Ivor Lewis esophagectomy for a leiomyoma in 2010 at an outside hospital (her anastomosis was approximately 30-35 cm from the incisors. The patient underwent a preoperative upper GI swallow showing a mid-esophageal narrowing by a submucosal mass. A subsequent EGD showed a submucosal mass (which was biopsied and shown to be a leiomyoma) extending from 24 cm to 30 cm from the incisors just above the esophagogastric anastomosis. The mass was near circumferential causing significant narrowing.
RESULTS:
Preoperatively we reviewed several options of resection approaches given what was discovered intra-operatively - we could simply do an enucleation or could be forced to do a total esophagectomy with a colon interposition (given the extent of the lesion seen on endoscopy and the history of the patient's prior esophagectomy). Ultimately, we were able to simply enucleate this lesion via a right thoracoscopic approach.
CONCLUSIONS: Esophageal leiomyomas are the most common benign esophageal tumors; however, they are quite rare. Also, recurrence of these lesions is incredibly rare if they are resected in entirety. These lesions should be included in the differential for any patients presenting with dysphagia


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