A CASE OF INCARCERATED DIAPHRAGMATIC HERNIA AFTER PERFORATION OF THE GASTRIC WALL AND DIAPHRAGMA DUE TO ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER

Abstract

A 67-year-old woman, who had undergone perforation of the gastric wall and diaphragma due to ESD for early gastric cancer and developed pneumothorax, was treated by endoscopic suture and thoracic drainage. Eighteen months later, she experienced upper left abdominal pain which worsened over time, Chest X-ray showed air bubbles in the left lower lung field. Chest CT showed that the stomach was incarcerated into the left thoracic cavity. Emergency laparotomy revealed that the stomach had herniated into the left thoracic cavity due to iatrogenic diaphragmatic injury. The diaphragmatic hernia was about 1.5 cm in diameter. After the prolapsed stomach was reintroduced into the abdominal cavity, the hernia orifice was directly closed. Her symptoms disappeared after surgery, and she has since been well with no signs of recurrence.