Coimbra Larissa Silva, Santos Matheus de Oliveira, Labate Giovanna Lima, Pereira Aline Sardow, Pereira Thiago Henrique Sigoli
Division of Trauma and Acute Care Surgery, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, BRA.
Cureus. 2025 Jun 11;17(6):e85750. doi: 10.7759/cureus.85750. eCollection 2025 Jun.
This report discusses a rare and challenging case of intrathoracic gastric perforation secondary to a recurrent strangulated hiatal hernia. The patient, a 52-year-old female with a prior history of thoracic and laparoscopic surgery for hiatal and diaphragmatic hernia, presented with epigastric and chest pain, which progressively led to hemodynamic shock. Initially, a pulmonary infection with parapneumonic pleural effusion was suspected. However, further imaging, including a contrast-enhanced computed tomography (CT) scan, revealed bilateral pleural effusion and herniation of the stomach with perforation into the thoracic cavity, which required emergency surgical intervention. Subtotal gastrectomy was performed, followed by peritoneostomy. Postoperatively, the patient was admitted to the intensive care unit. A few days later, she underwent peritoneostomy revision and Roux-en-Y gastrojejunostomy reconstruction. After clinical improvement, she was transferred to the general ward and subsequently discharged, with outpatient follow-up.
本报告讨论了一例罕见且具有挑战性的病例，即复发性绞窄性食管裂孔疝继发胸内胃穿孔。该患者为一名52岁女性，既往有因食管裂孔疝和膈疝接受胸外科和腹腔镜手术的病史，此次因上腹部和胸痛就诊，病情逐渐发展为血流动力学休克。最初怀疑是伴有类肺炎性胸腔积液的肺部感染。然而，进一步的影像学检查，包括增强计算机断层扫描（CT），显示双侧胸腔积液以及胃疝入胸腔并穿孔，这需要紧急手术干预。进行了胃次全切除术，随后进行了腹膜造口术。术后，患者被收入重症监护病房。几天后，她接受了腹膜造口术修复和Roux-en-Y胃空肠吻合术重建。临床症状改善后，她被转入普通病房，随后出院，并进行门诊随访。
