Ectopic gastric mucosa in the cervical esophagus presenting as a recurrent neck abscess: a case report Paul Daher, Evana Francis, Lara Raffoul, Edward Riachy ⁎ Department of Pediatric Surgery, Hotel Dieu de France Hospital, PO Box: 16- 6830, Beirut, Lebanon Received 12 February 2010; revised 16 March 2010; accepted 17 March 2010 Key words: Cervical esophagus; Ectopic gastric mucosa; Cervical abscess Abstract We report a unique case of ectopic gastric mucosa (EGM) in the cervical esophagus. The patient presented with a recurrent cervical abscess communicating through a fistula with the EGM. Surgical treatment consisted of complete excision. The postoperative course was complicated by a breach in the hypopharynx, which was treated conservatively, and a stenosis of the esophagus requiring balloon dilation. © 2010 Elsevier Inc. All rights reserved. Ectopic gastric mucosa (EGM) is found in the upper cervical esophagus in 0.1% to 10% of endoscopic studies [1,2]; it is most often asymptomatic on presentation. However, when symptoms occur, the lesions responsible for them include stricture, upper esophageal web, esophago- tracheal fistula, ulcer, and adenocarcinoma [1]. We present a case of EGM of the cervical esophagus manifesting as a recurrent neck abscess in a 4-year-old boy. 1. Case report A 4-year-old boy was referred to us for a 3-cm left cervical abscess associated with cervical lymphadenopathy, fever, and torticollis. A week before, he suffered from an upper respiratory tract infection. No signs of cellulitis, dysphonia, dyspnea, or dysphagia were noted. Ear, nose, and throat examination was otherwise unremarkable. Result of Epstein-Barr virus serology was negative. Cervical ultraso- nography revealed the mass to be anechogenic, slightly heterogeneous, measuring 3.2 × 2.8 cm, and located above and lateral to the left thyroid lobe with multiple lymph nodes in the jugulocarotid axis. The mass was incised and drained, and purulent fluid was obtained and sent for culture. A Penrose drain was left in place. The cultures grew colonies of an unspecified streptococcus with low resistance level. The patient was discharged receiving cefadroxil 50 mg/(kg d). Three weeks later, the child was readmitted for a recurrence of the cervical abscess. Surgical excision of the abscess was performed. The abscessed cyst was found lateral to the trachea, medial to the cervical vessels and the sternocleidomastoid muscle, and superior to the left thyroid lobe. A third branchial arch cyst was suspected, and a more complete excision with fistulography was planned after the resolution of the infection. Two weeks later, the child was hospitalized for another recurrence of the abscess. Symptoms included local erythema and slight induration, without dysphagia, dys- phonia, or dyspnea. Repeat cervical ultrasonography raised the suspicion of a fistulous tract extending posterolaterally to the left pyriform sinus. The child was reoperated for ⁎ Corresponding author. Tel.: +961 1 513 497 1268; fax: +961 1 615295. E-mail address: eddy_riachy@msn.com (E. Riachy). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2010.03.022 Journal of Pediatric Surgery (2010) 45, E15–E17