Although rare, fibrovascular polyps comprise the majority of benign tumor-like lesions of the esophagus characterized by the development of pedunculated intraluminal masses. Clinically, they do not present specific symptoms and are often misdiagnosed or even undiagnosed until they grow to gigantic sizes. Because these lesions are pedunculated they may have a spectacular clinical presentation, including regurgitation of a fleshy mass into the mouth. Usually these polyps arise from the cervical esophagus, inferiorly to the cricopharyngeal muscle at the Laimer's triangle, which reveals their trend to prolapse into the mouth causing the characteristic "regurgitation of a fleshy mass" . The redundant mucosa in the above region of the esophagus being highly mobile is assumed to result in the polyp formation, while the propulsive act of swallowing permits its caudal extension.
Their elongated "sausage-like" characteristic appearance is believed to be the result of the traction during peristalsis and swallowing .
Initial diagnosis in the majority of cases is made by barium esophagogram . This, usually, reveals an intraluminal contrast filling defect within a widened esophagus. The correct diagnosis can usually be suggested radiographically by the presence of a smooth, sausage-like defect with a discrete bulbous tip . Many times diagnosis to be established needs additional esophagoscopy, although detection of FVP might be difficult or even impossible due to their intraluminal location and composition that looks like the esophageal mucosa [7, 8]. Up to 25% of cases might be missed on endoscopy due to the normal squamous epithelium lining the polyp.
Resection, in most cases, is advocated as soon as a large fibrovascular polyp is detected to eliminate the potential risk of asphyxiation. Less usual indications for surgery include dysphagia and anemia due to gastrointestinal bleeding from the ulcerative tip of the polyp. Malignant transformation is extremely rare [9, 10].
Endoscopic removal of small FVPs seems feasible. Surgical excision is mandatory whenever the polyp gets large dimensions and is performed, preferably, through a cervical esophagotomy. Surgical removal remains the treatment of choice.
Since the pedicle has to be resected under direct vision, the incision needed to expose the esophagus has to be made opposite to the site of origin of the lesion.
Making the esophagotomy to the side where the polyp originates can be disastrous, with unpleasant incidents such as severe hemorrhage and even inability to excise the polyp as a whole and leaving material that can recur.
Consequently, knowing the exact site of origin of the pedicle of the FVP is extremely important when deciding to proceed to surgical removal of such a polyp. This knowledge can be provided, preoperatively, most of the times, by modern imaging techniques (CT, MRI).
Today, planning the proper surgical approach for the resection of a giant fibrovascular polyp, has an important ally, modern imaging, which can provide important information concerning the exact location of the pedicle.