Intramural Lesions

Although rare, leiomyomas are the most common benign esophageal neoplasm. When they must be removed, they are usually enucleated. For lesions of the upper and middle thirds of the esophagus, a right thoracotomy is most often used to avoid the aortic arch [32,33]. Videothorascopic enucleation is a new alternative to open thoracotomy [34]. When the distal esophagus is involved, a left thoracotomy is preferred [35]. Usually, when the esophageal muscle fibers are exposed, they are thinned and splayed out over the tumor [35]. An extramucosal defect may be left behind. This resultant weakness in the wall can result in a mucosal bulge, an acquired pseudodiverticulum (Fig. 2.10).

Figure 2.10. Pseudodiverticulum following extramucosal lesion resection.

Oblique film from an esophagogram showing a bulge from the distal esophagus in a patient with previous resection of a leiomyoma. This collection is a pseudodiverticulum following the myotomy necessary for the removal of the tumor.

Figure 2.10. Pseudodiverticulum following extramucosal lesion resection.

Oblique film from an esophagogram showing a bulge from the distal esophagus in a patient with previous resection of a leiomyoma. This collection is a pseudodiverticulum following the myotomy necessary for the removal of the tumor.

Similarly, duplication cysts of the esophagus may simply be enucleated. The esophagus may return to a normal appearance postopera-tively or may show pseudodiverticular formation similar to that following removal of a leiomyoma (Fig. 2.11). One alternative to enu-cleation is opening the cyst and removing its lining; marsupialization is another.

Figure 2.11. Pseudodiverticulum following extramucosal lesion resection.

Frontal film of the distal half of the thoracic esophagus demonstrates a broad-based outpouching (pseudodiverticulum) of the right lateral wall of the esophagus following removal of an esophageal duplication cyst.

Figure 2.11. Pseudodiverticulum following extramucosal lesion resection.

Frontal film of the distal half of the thoracic esophagus demonstrates a broad-based outpouching (pseudodiverticulum) of the right lateral wall of the esophagus following removal of an esophageal duplication cyst.

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