Lalezari Sepher, Hanak Courtney R, Husted Thomas
The Jewish Hospital, 4777 E Galbraith Rd, Cincinnati, OH 45236, USA.
John Hopkins Hospital, 601 N Caroline St, Baltimore, MD 21287, USA.
Ann Med Surg (Lond). 2018 Jul 24;33:13-15. doi: 10.1016/j.amsu.2018.07.007. eCollection 2018 Sep.
Hiatal hernia is rare after transhiatal esophagectomy occurring in less than 2% of patients [5]. Due to the rare incidence of hiatal hernias after transhiatal esophagectomy overlooking this differential in a symptomatic patient can be problematic. Patients can presents with recurrent pneumonia, complaints of reflux, and in the case presented small bowel obstructions. Surgery has been the mainstay of treatment for symptomatic hiatal hernias. This case report poses that nonoperative management is a viable treatment option for patients with complicated hiatal hernias after transhiatal esophagectomy.
We present the case of a mechanical small bowel obstruction occurring at the esophageal hiatus in a patient four years after transhiatal esophagectomy. The patient was successfully managed nonoperatively with resolution of small bowel obstruction and persistent hiatal hernia.
Hiatal hernias after transhiatal esophagectomy are a rare entity. Complications of these hernias with mechanical small bowel obstructions are even less described in the current literature. It is important to recognize hiatal hernias as a potential cause of obstructive symptoms after esophagectomy. While surgical intervention may be inevitable in certain population of patients. Initial nonoperative management is a viable treatment option and should be utilized in high risk operative patients.
经胸食管切除术后食管裂孔疝罕见，发生率不到2%[5]。由于经胸食管切除术后食管裂孔疝发生率低，对有症状患者忽视这种鉴别诊断可能会有问题。患者可能出现反复肺炎、反流症状，以及本例中的小肠梗阻。手术一直是有症状食管裂孔疝的主要治疗方法。本病例报告提出，对于经胸食管切除术后合并复杂食管裂孔疝的患者，非手术治疗是一种可行的治疗选择。
我们报告一例经胸食管切除术后四年患者在食管裂孔处发生机械性小肠梗阻的病例。该患者通过非手术治疗成功治愈，小肠梗阻缓解，食管裂孔疝持续存在。
经胸食管切除术后食管裂孔疝是一种罕见疾病。目前文献中对这些疝合并机械性小肠梗阻的并发症描述更少。认识到食管裂孔疝是食管切除术后梗阻症状的潜在原因很重要。虽然在某些患者群体中手术干预可能不可避免。初始非手术治疗是一种可行的治疗选择，应在高风险手术患者中使用。
