2022 Volume 42 Issue 1 Pages 41-45
A 72-year-old man with hematemesis visited a neighborhood hospital, where endoscopy revealed bleeding from an ulcer on the lesser curvature of the upper body of the stomach. The patient was referred to our hospital for endoscopic hemostasis; however, endoscopy performed at our hospital suggested possible perforation at the site of the bleeding lesion. Computed tomography revealed herniation of the stomach into the mediastinum with an upside-down stomach, as well as free air and a fluid collection within the hernia sac, and free mediastinal air. We diagnosed gastric perforation within the esophageal hiatus hernia sac and performed emergency laparoscopic surgery. The perforation was closed with sutures using the lesser omentum for coverage, and the stomach and abdominal walls were sutured to prevent reherniation of the stomach. The patient’s postoperative course was uneventful, and he was discharged 19 days after the surgery. Gastrointestinal perforation within an esophageal hiatus hernia sac could become fatal in patients who develop severe mediastinal or intrathoracic infection. However, laparoscopic surgery is a useful therapeutic option for patients in a good general condition without thoracic cavity or mediastinal penetration.
