Jain Vishu, Soni Subhash C, Varshney Peeyush, Varshney Vaibhav K, Selvakumar B
Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IND.
Cureus. 2023 Jan 1;15(1):e33214. doi: 10.7759/cureus.33214. eCollection 2023 Jan.
Post-esophagectomy hiatal hernia is a rare complication having varied presentation from asymptomatic cases detected incidentally on follow-up imaging to acute surgical emergency for strangulation or gangrene. Patients presenting as a surgical emergency have a prolonged post-operative course with significant morbidity. We present three cases of post-esophagectomy hiatal hernia. Two of the three cases were operated for esophageal squamous cell carcinoma (SCC) and one patient was operated for esophageal leiomyomatosis. Two of the three cases (SCC and esophageal leiomyomatosis) underwent minimally invasive Mckeown's esophagectomy and one case underwent robotic transthoracic Ivor-Lewis esophagectomy. All cases underwent contrast enhanced CT (CECT) and were biopsy proven prior to their index surgery. Both cases of SCC had prior neoadjuvant chemoradiation followed by surgery while esophageal leiomyomatosis underwent upfront surgery. All three cases have improved symptomatically and are doing well on follow up (case 1 - 12 months, cases 2 and 3 - 3 months). All three of our cases have different clinical presentation in terms of symptoms, severity, and time duration from index surgery. Two of the three cases underwent emergency surgery and one case which was asymptomatic detected incidentally on surveillance imaging and was managed conservatively. Post-esophagectomy hiatal hernia is a rare entity with varying presentation. The management options in such cases vary depending on the severity of symptoms and time after index surgery. In cases presenting as surgical emergency, successful management depends on prompt detection, early surgery, proper post-operative care, and rehabilitation.
食管切除术后裂孔疝是一种罕见的并发症，其表现多样，从随访影像偶然发现的无症状病例到因绞窄或坏疽导致的急性外科急症。表现为外科急症的患者术后病程延长，并发症发生率高。我们报告三例食管切除术后裂孔疝病例。三例中的两例因食管鳞状细胞癌（SCC）接受手术，一例因食管平滑肌瘤病接受手术。三例中的两例（SCC和平滑肌瘤病）接受了微创McKeown食管切除术，一例接受了机器人辅助经胸Ivor-Lewis食管切除术。所有病例在初次手术前均接受了对比增强CT（CECT）检查并经活检证实。两例SCC患者术前均接受了新辅助放化疗，然后进行手术，而食管平滑肌瘤病患者接受了一期手术。所有三例患者症状均有改善，随访情况良好（病例1 - 12个月，病例2和3 - 3个月）。我们的所有三例病例在症状、严重程度以及自初次手术以来的持续时间方面都有不同的临床表现。三例中的两例接受了急诊手术，一例在监测影像中偶然发现无症状，采取了保守治疗。食管切除术后裂孔疝是一种罕见的疾病，表现各异。此类病例的治疗选择因症状严重程度和初次手术后的时间而异。对于表现为外科急症的病例，成功的治疗取决于及时发现、早期手术、适当的术后护理和康复。
