Abstract
A 78-year-old woman who presented to our hospital because of heartburn and sensation of food sticking in swallowing was found to have a huge submucosal tumor on the right-sided wall of esophagus 25-29 cm distant from the incisor teeth by esophagogastroduodenoscopy. A chest contrast-enhanced CT scan revealed a 44-mm diameter tumor in the posterior mediastinum just under the tracheal bifurcation which had obstructed the esophageal lumen from the right side. She was operated on with a diagnosis of a submucosal tumor of the esophagus. Right thoracotomy revealed a tumor at the arch and tail side of azygos vein which continued from the right-sided wall of esophagus. Enucleation of the tumor left a defect in the esophageal muscle layer which was 55 mm in long axis and encircled a half of the circumference of the esophagus. We harvested a pedicled intercostal muscle flap from the right 4-5 intercostal muscle to cover the defect in the muscle layer. The enucleated specimen was a 40-mm pale-yellow solid tumor, and the histopathological diagnosis was esophageal schwannoma. The postoperative course was uneventful and her difficulty in swallowing completely improved. Sometimes we encounter case reports of esophageal submucosal tumor in which esophageal resection could be avoided by covering the esophageal wall defect after tumor enucleation with an intercostal muscle flap. Among of such cases, our case in which the defect was as largest as 55 mm in diameter might serve as a valuable experience in considering the appropriate candidates for this surgical procedure.
