pulmonary sequestration ( ps ) is an extremely rare malformation defined as a portion of lung tissue isolated from the pulmonary system . this condition , which arises from the primitive foregut , has no bronchial connections and its vascular supply can originate in the aorta , abdominal visceral vessels or coronary system . the intralobar type has a segment of normal lung , while the extralobar type has a completely separated pleura covering of lung tissue and can be supra- or sub - diaphragmatic . the latter is called intra - abdominal ps and is the least common subtype ( 2.5% ) . as a congenital malformation , pss they may remain asymptomatic initially and are usually discovered accidentally in imaging studies during adulthood , when adrenal disease is often suspected . although fewer than 20 cases of ps have been reported in adults , this condition should be included in the differential diagnosis of a left - sided suprarenal mass . as in our case , the evaluation should include imaging studies and biochemical testing to exclude adrenal functional tumors . the radiological features usually include a left - sided infradiaphragmatic cystic mass with calcified areas and its vascularization can be demonstrated , which could not be proven in our case . however , although computed tomography and magnetic resonance imaging can suggest the diagnosis of ps , these techniques do not provide a conclusive diagnosis of extralobar ps . however , the mass is usually located in an area not easily amenable to percutaneous approach . there are no cases of malignant transformation reported in adults but surgery is usually required to obtain a definitive diagnosis . only two cases of laparoscopic resection of a ps in an adult have been reported previously and both were accomplished via the lateral approach commonly used to perform a laparoscopic left adrenalectomy . in contrast to these reports , we used an anterior approach due to the gej suspected origin of the mass and it was not necessary to remove the adrenal gland . in summary , extralobar intra - abdominal ps is an extremely rare condition during adulthood but this diagnosis should be included in the differential diagnosis of a left - sided suprarenal mass . due to the difficulty in achieving a definitive preoperative diagnosis , surgery is recommended . laparoscopic resection is safe and effective but careful preoperative imaging studies are recommended in order to plan the most suitable approach . written informed consent was obtained from the patient for publication of this case report and accompanying images . a copy of this written consent is available for review by the editor - in - chief of this journal on request . herrero - bogajo and j. picazo - yeste performed the surgery . c. moreno - sanz wrote the manuscript . a. morandeira - rivas , m. manzanera - daz and c. sedano - vizcaino were involved in the management and follow up of the patient .
introductionpulmonary sequestration ( ps ) is an extremely rare malformation defined as a portion of lung tissue isolated from the pulmonary system . 
 pss are classified into intralobar type and intra - abdominal ps that represents only 2.5% of cases . 
 there are 20 cases of ps reported in adults and only two were managed by laparoscopic approach . 
 we report a case of intra - abdominal ps mimicking a gastroesophageal duplication cyst in an adult . besides its rarity 
 , this is the first intra - abdominal ps in an adult managed by an anterior laparoscopic approach.presentation of casea 60-year - old female patient had had epigastric and left upper quadrant pain for several days . 
 physical examination was normal . 
 image test were consistent with a gastroesophageal duplication . 
 the patient was taken to the operating room for laparoscopic exploration and resection . 
 the pathological diagnosis was extralobar pulmonary sequestration.discussionless than 20 cases of ps have been reported in adults and only two cases were managed by a lateral laparoscopic approach . 
 in contrast to these reports , we used an anterior approach due to the gej suspected origin of the mass.conclusionextralobar intra - abdominal ps is an extremely rare condition during adulthood but this diagnosis should be included in the differential diagnosis of a left - sided suprarenal mass . due to the difficulty in achieving a definitive preoperative diagnosis , surgery is recommended . 
 laparoscopic resection is safe and effective but careful preoperative imaging studies are recommended in order to plan the most suitable approach .