Fujita Akitsugu, Watanabe Masaya, Nishida Masato, Sato Shinsuke, Ohata Ko, Kanemoto Hideyuki
Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, JPN.
Cureus. 2025 Jun 12;17(6):e85838. doi: 10.7759/cureus.85838. eCollection 2025 Jun.
Intrathoracic omental hernia (ITOH) is a rare disease with only 17 previously reported cases. ITOH is a hiatal hernia in which the hernia content is only greater omentum, but the cause of the onset is unknown. There have been reports of ITOH requiring emergency surgery due to intussusception during follow-up, and surgery is recommended even if the patient is asymptomatic. The patient is a 79-year-old man. He visited his local doctor with a chief complaint of chest tightness during swallowing. Chest X-ray revealed a mediastinal tumor, and he was referred to our hospital. He was diagnosed with ITOH by MRI and contrast-enhanced CT scan. He was symptomatic and underwent laparoscopic hernia repair. Intraoperative findings revealed a greater omental prolapse into the posterior mediastinum from the right side of the esophageal hiatus. The greater omentum was returned manually into the abdominal cavity, and the hernial orifice was sutured closed with a 3-0 barbed suture. The patient had a good postoperative course and was discharged home on the sixth postoperative day. Laparoscopic surgery for ITOH was considered to be an effective treatment method because of its low invasiveness and easy repair of the hernial orifice.
胸内大网膜疝（ITOH）是一种罕见疾病，此前仅有17例报道。ITOH是一种食管裂孔疝，疝内容物仅为大网膜，但其发病原因尚不清楚。有报道称，ITOH患者在随访期间因肠套叠需要紧急手术，即使患者无症状也建议进行手术。该患者为一名79岁男性。他因吞咽时胸部发紧为主诉就诊于当地医生。胸部X线检查发现纵隔肿瘤，遂转诊至我院。通过MRI和增强CT扫描，他被诊断为ITOH。他有症状，接受了腹腔镜疝修补术。术中发现大网膜从食管裂孔右侧脱垂至后纵隔。将大网膜手动回纳至腹腔，用3-0倒刺缝线缝合疝孔。患者术后恢复良好，术后第六天出院。由于其微创性和易于修补疝孔，腹腔镜手术被认为是治疗ITOH的有效方法。
