PMC5758358_01
(a) Fetal magnetic resonance imaging shows a cystic lesion with slightly high intensity in true FISP and HASTE mode (arrow). (b) Esophagography shows a hiatal hernia and gastroesophageal reflux (arrow).
10-1055-s-0037-1612611-i170358cr-1.jpg
PMC5758358_01_10-1055-s-0037-1612611-i170358cr-1.jpg
FI170358cr-1
A 2-year-old girl was diagnosed with fetal magnetic resonance imaging as a mediastinal mass lesion ( Fig. 1a ). Two weeks after birth, the patient developed gastroesophageal reflux (GER), and esophagography showed a hiatal hernia ( Fig. 1b ).
(a, b) Postnatal computed tomography shows two anomalous systemic arteries originating from the left gastric artery and supplying the lung mass. (c, d) All drainage veins in the mass drained to the portal vein.
10-1055-s-0037-1612611-i170358cr-2.jpg
PMC5758358_01_10-1055-s-0037-1612611-i170358cr-2.jpg
FI170358cr-2
All drainage veins in the mass drained to the portal vein ( Fig. 2a - d ).
(a, b) Three port sites were established. (c) To secure the surgical field, we used stay sutures in the hernia ring to expand this field and elevate the left liver lobe. We elevated the esophagus to prepare for fundoplication in the usual manner. (d) After dissection of three aberrant vessels, the sequestrated lung was grasped via the esophageal hiatus and removed through the umbilical port site. (e) The esophageal hiatus was repaired and Nissen's fundoplication was performed in the usual manner.
10-1055-s-0037-1612611-i170358cr-3.jpg
PMC5758358_01_10-1055-s-0037-1612611-i170358cr-3.jpg
FI170358cr-3
Three port sites were used ( Fig. 3a ), and a wound edge protector was inserted at the umbilical site to allow use of the scope and grasping forceps. To better expose the surgical field, we used stay sutures (3-0 ETHIBOND; Ethicon, Somerville, New Jersey, United States) in the hernia ring to expand this field and elevate the left liver lobe ( Fig. 3c ). Teleflex, Wayne, Pennsylvania, United States) that were entered through the 5-mm port for aberrant vascular control to avoid burn injury from hemoclips when using energy devices intraoperatively ( Fig. 3d ). The anterior and posterior aspects of the esophageal hiatus were repaired with ETHIBOND sutures, and Nissen's fundoplication was performed in the usual manner ( Fig. 3e ). This procedure was performed with only three port sites ( Fig. 3b ).