A Case of the Hernia as Intestine Intrusion into the Antethoracic Route After Esophagectomy

Abstract

A 60-year-old man was diagnosed with esophageal carcinoma. Subtotal esophagectomy via right-sided thoracolaparotomy, three-field dissection, construction of antethoracic route esophageal reconstruction using right hemicolon, and revascularization were performed. From the postoperative day 3, the patient suffered frequent diarrhea due to pseudomembranous enterocolitis, but recovered after administration of vancomycin. On the postoperative day 11, CT revealed marked swelling of the reconstructed intestine on the thoracic wall and enhancement of the entire abdomen; we established a diagnosis of ileus due to the hernia as intestine intrusion into the right side below the anterior thoracic wall. We performed an emergency operation the same day to repair the hernia and released pressure by inserting an ileus tube. Although the patient again had postoperative pseudomembranous enterocolitis, the course went well without major complications. On the postoperative day 35 of the second surgery, he was discharged from the hospital in remission.
Hernia after esophageal carcinoma surgery is very rare. Most of the cases are intrusions into the posterior mediastinum, and intestinal intrusion into the thoracic wall path has never been reported. We report our experience of a case of intestine intrusion into the antethoracic route after esophagectomy.