A Case with Hiatus Hernia After Esophagectomy Complicated with Bowl Strangulation

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 33; no. 6; pp. 1027 - 1030
• Main Authors: Tanaka, Hiroaki, Takii, Mamiko, Muguruma, Kazuya, Hirakawa, Kousei, Maeda, Kiyoshi, Ohhira, Masaichi, Kubo, Naoshi
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 30.09.2013; 日本腹部救急医学会
• Subjects: 絞扼性イレウス; 食道癌術後; 食道裂孔ヘルニア
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.33.1027

A 79-year-old man who underwent an uneventful radial esophagectomy for superficial abdominal esophageal cancer suddenly complained of abdominal pain about one year after the operation. After examination for the possible cause of the abdominal pain with colonoscopy, the patient complained of dyspnea and his blood pressure dropped, so he was taken to the emergency department of our hospital. Chest X-ray and computed tomography images showed bowel obstruction due to a diaphragmatic hernia, and an emergency laparotomy was performed. Most of small intestine and transverse colon had prolapsed into the left thoracic cavity through the esophageal hiatus and ischemic necrosis of the terminal ileum was observed. The necrotic intestine was resected and the diaphragmatic defect was sutured with unabsorbable thread. The postoperative course was uneventful and he was discharged on the 42nd postoperative day. In the present case, the diaphragmatic hernia occurred because of insufficient repair of the hiatus, the increase in abdominal cavity pressure with the colonoscopy and increased bowel movement due to decreased fatty tissue in the mesentery because of malnutrition after the esophagectomy.