Intra-abdominal Extralobar Pulmonary Sequestration (EPS)
Intra-abdominal extralobar pulmonary sequestration (EPS) is a mass of pulmonary tissue without connection to the bronchial tree that has direct blood supply from a branch of the aorta, according to specialists at the University Center for Fetal Medicine.
EPS is found in the left hemithorax in 90 percent of the cases, but 10 percent can be intra-abdominal. Intra-abdominal EPS is almost always found on the left side above the kidney and can be associated with left congenital diaphragmatic hernia (CDH). Delivery at a tertiary care center is advised as immediate assessment by a pediatric surgeon is needed. Postnatal ultrasound and CT scan should be done shortly after birth to evaluate the mass and look for associated anomalies or metastases.
Even though spontaneous regression has been reported, surgical excision is the treatment of choice because of the small risk of malignant degeneration and to obtain a definitive diagnosis.
Once completely resected, intra-abdominal EPS has no long-term sequelae. Bleeding complications can be seen during resection if the aortic blood supply is not ligated early and proximally.
The majority of prenatally diagnosed intra-abdominal masses do not require immediate intervention, but full evaluation and close follow-up after delivery is importance. This requires early involvement, preferably in the prenatal period, of an experienced pediatric surgeon to outline the management and potential outcome for these lesions.