Enterogenic cysts of the gastrointestinal tract are rare congenital anomalies that can be found anywhere from the oral cavity to the rectum, arising from impaired differentiation of the foregut during the 5th–8th week of embryogenesis. Enterogenic esophageal cysts account for 20% of all gastrointestinal enterogenic cysts. This condition is often complicated by the development of respiratory failure and dysphagia due to compression of the trachea and esophagus.

This report presents a 10-month-old child admitted to the Thoracic Surgery Department of the Federal State Autonomous Institution "National Medical Research Center for Children's Health" of the Ministry of Health of Russia with complaints of noisy breathing, shortness of breath, and dysphagia. Examination revealed a giant mediastinal cyst causing life-threatening compressive stenosis of the trachea and esophagus. The patient successfully underwent thoracoscopic surgery. The key to successful minimally invasive surgical treatment, alongside radical removal of the malformed tissue, is the preservation of adjacent anatomical structures, particularly the vagus nerves. In this clinical case, fibers of both vagus nerves were splayed over the giant cyst, creating a high risk of iatrogenic injury. The application of a precise thoracoscopic dissection technique allowed for complete isolation and preservation of both nerves, thereby preventing the development of serious postoperative complications such as dysphagia, vocal fold paresis, and gastroparesis.

The thoracoscopic approach is a highly effective, minimally invasive, and radical method for treating giant enterogenic mediastinal cysts in infants. This method allows for thorough intraoperative visualization and precise dissection of the formation while preserving critically important anatomical structures, specifically the vagus nerves. The success of the surgery depends on the high qualifications of the surgical team and the resources of a specialized center.