2016 Volume 30 Issue 1 Pages 40-45
A 77-year-old woman complained of chronic cough and was suspected to have left lung cancer. Intrapericardial left pneumonectomy was performed because of hilar lymph node swelling, and postoperative phrenic palsy was noted. On postoperative day 4, anorexia and vomiting appeared and the chest radiograph revealed an elevated left diaphragm and gastric dilation. Conservative medical treatment was performed but the symptom did not improve, and esophageal dilation was confirmed on a chest radiograph on postoperative day 9. Gastrointestinal fiberscopy and a contrast radiograph of the upper gastrointestinal tract with gastrograffin revealed that flexion of the esophagogastric junction due to marked diaphragmatic eventration caused esophageal obstruction. Emergent diaphragm plication via a 6th thoracotomy was performed to treat the paralyzed hemi-diaphragm; the diaphragm was relaxed but showed no injury. The diaphragm was recovered to a normal position and both symptoms were resolved after the operation.