Laparoscopic transhiatal management of a rare case of esophageal lung and medialized stomach associated with heterotaxy – a technical case report

Introduction: Esophageal lung is a rare and complex congenital malformation, in which the bronchus of one or several pulmonary lobes arises from the esophagus. It is frequently associated with other malformations. Surgical management needs individual approaches, is often complex and depends on concomitant disorders. Case description: A 3-month-old male was referred for further management of a left lower esophageal pulmonary lobe associated with a laryngotracheal cleft, congenital heart disease, heterotaxy, medialized stomach with additional microgastria and severe gastroesophageal reflux leading to recurrent left lower lobe pneumonia. Technical management: A minimally invasive, laparoscopic strategy via abdominal access only was used to cure the gastroesophageal reflux and recurrent pneumonias. Laparoscopic dissection of the thoracic esophagus was performed up to the junction of the aberrant left lower lobe bronchus, which was subsequently clipped, avoiding gastroesophageal reflux into the left lower lobe. Fundoplication and laparoscopic gastrostomy were performed simultaneously. The patient underwent closure of the laryngotracheal cleft in a second procedure. Conclusion: Transhiatal clip ligation is an innovative approach to esophageal lower pulmonary lobes. The intervention prevents recurrent pneumonias associated with aspiration of feeds and gastroesophageal reflux. Whether an interval lobectomy is necessary at a later date must be determined by the clinical course.