We encountered a case of esophageal mucocele with progressive respiratory symptoms which originated from an excluded thoracic esophagus that was closed at both the proximal and distal ends, and which occurred 24 years after esophageal bypass surgery for a spontaneous esophageal rupture. The patient was a 64-year-old male who was treated by a temporary external drainage for relief of his symptoms without subsequent complete resection of the mucocele via thoracotomy, because of the high surgical risks associated with such a procedure. Four-hundred and fifty milliliters of waste removed during the initial external drainage showed no signs of inflammation or malignancy, suggesting that the reason this excluded esophagus was a symptomatic mucocele was not the observed vigorous secretion, because of irritated esophageal mucosal cells or malignant cells, but instead was the result of gradual accumulation of secretions from the normal esophageal mucosa. This case suggests that an excluded esophagus without any inflammation or malignancy could form a large mucocele that can cause serious symptoms, for example respiratory difficulty, even after an extremely long interval. Although he has been both relapse-free and drainage-free for more than 5 years, further long-term follow-up in this case is mandatory.
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