Drescher D, Gockel I, Helmreich-Becker I, Lang H
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
Dtsch Med Wochenschr. 2011 Feb;136(5):213-6. doi: 10.1055/s-0031-1272513. Epub 2011 Jan 26.
A 74-year-old woman was admitted with a history of recurring dyspnea for several months. During radiological examination of the chest computed tomography demonstrated a giant paraesophageal hernia containing transverse colon with a significant amount of paracolic fat tissue. Physical examination was unremarkable.
Routine blood tests and abdominal ultrasound were within the normal range. Endoscopy showed a normal upper and lower gastrointestinal tract and barium swallow was normal without any esophageal motor dysfunction. The esophagogastric junction and gastric fundus were below the diaphragm.
Laparoscopy revealed the colonic herniation and mediastinal adhesiolysis, complete resection of the hernia sac and reposition of the intrathoracic migrated transverse colon were undertaken. Hiatal repair was performed by anterior and posterior hiatoplasty and construction of an anterior 180˚ semifundoplication with fundopexy.
Patients with giant paraesophageal hernias often present with nonspecific cardiac and respiratory symptoms and the condition is often misdiagnosed. If it is demonstrated, a possible abdominal involvement should be looked for. Minimally invasive surgery is feasible and efficacious in this condition and in addition to being better tolerated by the patient provides a far better visualization of the intrathoracic parts of a type IV hiatal hernia to the surgeon.
一名74岁女性因数月来反复出现呼吸困难入院。胸部计算机断层扫描显示巨大食管旁疝，疝内容物为横结肠及大量结肠旁脂肪组织。体格检查未见异常。
血常规及腹部超声检查均正常。内镜检查显示上、下胃肠道正常，吞钡检查正常，无食管运动功能障碍。食管胃交界处及胃底位于膈肌下方。
腹腔镜检查发现结肠疝并进行纵隔粘连松解，完整切除疝囊，将胸腔内移位的横结肠复位。通过前后裂孔成形术进行裂孔修补，并进行180˚前半胃底折叠术加胃底固定术。
巨大食管旁疝患者常表现为非特异性心脏和呼吸系统症状，该病常被误诊。一旦确诊，应排查可能存在的腹部病变。微创手术在这种情况下是可行且有效的，除了患者耐受性更好外，还能为外科医生提供对IV型裂孔疝胸腔内部分更好的视野。
