2013 Volume 33 Issue 5 Pages 913-917
A 62-year-old man underwent a subtotal esophagectomy via laparotomy and right thoracotomy for advanced esophageal cancer. Reconstruction was performed with a gastric conduit through the posterior mediastinal route, with jejunostomy. On postoperative day 7, anastomotic leakage was caused by necrosis of the gastric conduit. After resection of the partially necrotic segment of the gastric conduit the distal gastric conduit was placed on the antethoracic subcutaneous portion. Esophagostomy was performed through the reopened cervical wound. The patient was referred to our hospital for reconstruction after stabilization of the general condition. Reconstruction was performed using a gastric conduit and a free jejunal graft with microvascular anastomosis. On postoperative day 4, the patient complained of abdominal pain and vomiting. An abdominal CT showed hepatic portal venous gas in the left lobe of the liver and pneumatosis cystoides intestinalis in the wall of the small intestine. The emergency operative findings showed adhesion of the jejunum on the anal side of the jejunostomy to the peritoneum. The distal small intestinal loop was impacted between this adhesion and the jejunostomy as an internal hernia. However, since no circulatory disturbance of the small intestine was observed, the small intestine was not resected. The postoperative course was uneventful, and the patient was discharged from our hospital on postoperative day 21. We report this rare case of hepatic portal venous gas and pneumatosis cystoides intestinalis resulting from internal hernia after esophageal cancer surgery.
