Management of Incidental Peri-Diaphragmatic Cyst During Bariatric Surgery: A Case Report and Review of the Literature.

Bronchogenic cysts are rare congenital anomalies that originate from the foregut and are often incidentally detected in adults during imaging studies. While they are typically asymptomatic, they can pose significant challenges during surgical interventions, particularly in patients undergoing bariatric surgery. We report a case of a 49-year-old woman with morbid obesity (BMI = 40 kg/m2) who underwent a preoperative evaluation for bariatric surgery. During routine ultrasonography, a 4 cm anechoic retrogastric cyst was identified, initially thought to represent a pancreatic pseudocyst. Computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen confirmed that the cyst originated from the right crus, compressing rather than arising from the pancreas. We therefore opted for a diagnostic laparoscopy to determine the origin of the cyst and manage it if feasible, along with a vertical sleeve gastrectomy to address obesity. The surgical procedure involved gaining access to the cyst through the lesser sac after division of the greater omentum. The cyst was excised en bloc, and a vertical sleeve gastrectomy was performed over a 36F bougie. Histology demonstrated that the examined sections revealed a cyst lined by respiratory-type epithelium. The cyst wall also contained smooth muscle bundles, supporting the possibility of a bronchogenic cyst. The patient tolerated oral intake, ambulated with minimal discomfort, and was discharged with an uncomplicated postoperative course. The report highlights the importance of thorough preoperative evaluation and appropriate management of incidental findings during bariatric surgery. Our experience demonstrates that a comprehensive preoperative assessment is vital in bariatric patients, as it allows for the identification and management of incidental findings such as bronchogenic cysts. A combined surgical approach can enable successful outcomes without delaying the planned bariatric intervention.