Abstract
BackgroundWhile anastomotic leakage, recurrent laryngeal nerve paralysis, and pneumonia are well-known complications of esophagectomy, the incidence of hiatal hernia after esophagectomy for carcinoma has been reported to only be between 0.6 and 10%. We report a very rare case of hiatal hernia with transverse colon rupture in the mediastinum after esophagectomy in a 65-year-old woman.Case presentationThe patient underwent definitive chemoradiotherapy for clinical stage IIA esophageal squamous cell carcinoma and salvage esophagectomy with gastric tube reconstruction through a posterior mediastinum route for residual carcinoma. Three years after the initial surgery, two metastatic nodules in the lateral and posterior segments of the liver were detected on follow-up CT and were treated with oral anticancer drugs. After 6 months, the patient was readmitted for anorexia. Upon admission, computed tomography revealed an ileus caused by a hiatal hernia. Emergent operative repair was performed; an incarcerated herniation of the transverse colon was perforated in the mediastinum, and partial transverse colon resection and colostomy were performed. Intensive care was required to control septic shock after surgery, and the patient was discharged on the 53rd postoperative day.ConclusionsCases of hiatal hernia with digestive tract prolapsing into the mediastinum after esophagectomy with reconstruction through posterior mediastinum are rare but potentially life-threatening complications.
Highlights
BackgroundAs esophagectomy for carcinoma of the esophagus becomes safer and less invasive thanks to improvements in medical treatment techniques and intensive care, patients survive longer with a lower incidence of complications
While anastomotic leakage, recurrent laryngeal nerve paralysis, and pneumonia are well-known complications of esophagectomy, the incidence of hiatal hernia after esophagectomy for carcinoma has been reported to only be between 0.6 and 10%
Surgical repair is often performed for symptomatic patients with hiatal hernias, and prophylactic repair is performed for some asymptomatic patients, but not for all
Summary
As esophagectomy for carcinoma of the esophagus becomes safer and less invasive thanks to improvements in medical treatment techniques and intensive care, patients survive longer with a lower incidence of complications. Case presentation A 65-year-old Japanese woman was admitted to our hospital with dysphagia and was diagnosed with clinical T2N0M0 stage IIA [Union for International Cancer Control (UICC), 8th edition] esophageal squamous cell carcinoma. She was treated with concurrent chemoradiotherapy (CRT). The patient was diagnosed with postoperative hiatal hernia with incarcerated digestive tract, and emergency operative repair was performed with open surgery through the abdomen. The distal transverse colon was incarcerated through the left side of diaphragmatic hiatal defect into the right mediastinum around the back of the gastric conduit (Fig. 2).
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