Santos Bruna do Nascimento, de Oliveira Marcos Belotto, Peixoto Renata D'Alpino
Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil.
Surgery Department of Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Oncologic Surgery Department of Hospital Israelita Albert Einstein, São Paulo, Brazil; Centro Oncológico Antônio Ermírio de Moraes, São Paulo, Brazil; Surgery Department of Hospital Israelita Albert Einstein, São Paulo, Brazil.
Case Rep Oncol. 2016 Feb 6;9(1):100-5. doi: 10.1159/000443633. eCollection 2016 Jan-Apr.
According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy.
A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery.
Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.
根据巴西国家癌症研究所的数据，在巴西，胃癌是男性第三大死因，女性第五大死因。手术切除是唯一可能治愈的治疗方法。与手术相关的最严重并发症是空肠食管吻合口瘘和裂开。食管裂孔疝是指腹腔内容物通过膈肌食管裂孔突出，不过这种情况在胃切除术中作为并发症很少被报道。
一名76岁男性被诊断为肠型胃腺癌。2015年5月19日，他接受了全腹腔镜辅助胃切除术和D2淋巴结清扫术。病理显示为pT4pN3胃腺癌。患者临床情况稳定，术后10天出院。随后他开始接受辅助性FOLFOX化疗；然而，在第二个周期化疗9天后，他因恶心和严重上腹痛被送往急诊室。CT扫描显示有食管裂孔疝且有绞窄迹象。患者接受了急诊疝修补术，术后无并发症。术后9天出院。
食管裂孔疝的记录并不完善，其在胃切除术中的发生是一种罕见的并发症。
