Surgical images: soft tissue. Tubular duplication of the esophagus.

emergency department with an impacted foreign body in the esophagus. His medical history was marked by a mild dysphagia for solid food, present since the age of 2 years. His physical examination was unremarkable. An upper endoscopy was performed. After a coin in the esophagus was removed, an esophageal stenosis and an orifice in the esophageal wall were noticed (Fig. 1). Biopsy of the double lumen showed chronic esophagitis. A barium esophagram (Fig. 2) was also carried out and contributed to a diagnosis of tubular duplication of the esophagus. Esophageal duplication is a rare congenital anomaly with an estimated incidence of 1 in 8200, representing about 10% of all foregut duplications. The cystic form is the most usual presentation of the duplication, whereas the tubular type accounts for only 5%–10% of cases. Esophageal duplication cysts are commonly found in the lower third (60%–95%) and on the right side, whereas the tubular form is frequently reported in the middle and lower esophagus The duplication may be discovered incidentally in adulthood; however, from 70%–90% of the cases present before 2 years of age. The most frequent symptoms are dysphagia, digestive hemorrhage, retrosternal pain and, especially, respiratory symptoms (recurrent pneumonia, stridor, respiratory distress) that may be present in more than 80% of the cases. Vertebral anomaly may be associated with the disease. This type of association may be explained in terms of notochordodysraphy (split notochord syndrome), the result of an abnormal division of the notochord in the third week of embryogenesis. However, Bremer suggests an error associated with the vacuolization of the esophagus in the fifth and seventh weeks of embryogenesis. The diagnosis may be carried out by