Murata S, Yamazaki M, Kosugi C, Hirano A, Yoshimura Y, Shiragami R, Suzuki M, Shuto K, Koda K
Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan,
Hernia. 2014;18(6):889-91. doi: 10.1007/s10029-013-1142-3. Epub 2013 Aug 6.
Hiatal hernias after total gastrectomy for advanced gastric cancer are very rare. We review a case of a 44-year-old male who presented with dyspnea and chest pain 2 days after total gastrectomy, lower esophagectomy, and splenectomy with retrocolic Roux-en-Y reconstruction approached by a left thoracoabdominal incision for gastric cancer at the cardia. Plain and cross-sectional imaging identified a large hiatal hernia protruding into the right thorax containing left-sided transverse colon and small intestine. Our patient underwent a laparotomy, and after hernia reduction the hiatal defect was repaired by direct suturing. He experienced anastomotic leakage and right pyothorax, but recovered. The potential cause is discussed here and the published literature on this rare complication is reviewed briefly.
进展期胃癌全胃切除术后的食管裂孔疝非常罕见。我们回顾了一例44岁男性患者的病例，该患者在因贲门癌行全胃切除、食管下段切除、脾切除及经左胸腹联合切口行结肠后Roux-en-Y重建术后2天出现呼吸困难和胸痛。平片和横断面成像显示一个巨大的食管裂孔疝突入右胸腔，疝内容物为左侧横结肠和小肠。我们的患者接受了剖腹手术，疝还纳后通过直接缝合修复了食管裂孔缺损。他出现了吻合口漏和右侧脓胸，但最终康复。本文讨论了可能的病因，并简要回顾了关于这一罕见并发症的已发表文献。
