期刊论文详细信息
Surgical Case Reports
Intrapericardial diaphragmatic hernia into the pericardium after esophagectomy: a case report
Kenitiro Kaneko1  Takuya Saito1  Takashi Arikawa1  Seiji Ishiguro1  Shintaro Kurahashi1  Shunichiro Komatsu1  Kohei Yasui1  Kenichi Komaya1  Masahiko Miyachi1  Tsuyoshi Sano1 
[1] Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University;
关键词: Esophageal cancer;    Intrapericardial hernia;    Diaphragmatic hernia;    Esophagectomy;    Autologous graft;    Rectus abdominis sheath;   
DOI  :  10.1186/s40792-018-0499-z
来源: DOAJ
【 摘 要 】

Abstract Background Intrapericardial diaphragmatic hernia (IPDH), defined as prolapse of the abdominal viscera into the pericardium, is a rare clinical condition. This case illustrates the possibility of IPDH after esophagectomy with antethoracic alimentary reconstruction, although such hernias are extremely rare. IPDH often presents with symptoms of bowel obstruction such as abdominal discomfort or vomiting. If not properly treated, life-threatening necrosis and/or perforation of the herniated contents may occur. Case presentation A 68-year-old Japanese man underwent subtotal esophagectomy with three-field lymph node dissection for treatment of esophageal cancer. Completion gastrectomy with perigastric lymph node dissection was also performed because the patient had previously undergone distal partial gastrectomy for treatment of gastric cancer. The alimentary continuity was reconstructed using the pedicled jejunal limb through the antethoracic route. When we separated the diaphragm from the esophagus and removed xiphoid surgically to prevent a pedicled jejunal limb injury, the pericardium was opened. The patient was readmitted to our hospital because of abdominal discomfort and vomiting 6 months after the esophagectomy. A diagnosis of IPDH after esophagectomy was made. The patient was treated by primary closure of the diaphragmatic defect using vertical mattress sutures and additional reinforcement of the closing defect using a graft harvested from the rectus abdominis posterior sheath. The postoperative course was uneventful, and he was discharged on the seventh day after hernia repair. Conclusions This patient’s clinical course provides two important clinical suggestions. First, we must be aware of the possibility of iatrogenic IPHD after esophagectomy with antethoracic alimentary reconstruction. Second, a graft from the rectus abdominis posterior sheath is beneficial in the treatment of IPDH.

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