Abstract
The patient, a 52-year-old man, underwent endoscopic subtotal esophagectomy, retrosternal gastric tube reconstruction, and 3-field lymph node dissection for stageII thoracic esophageal cancer in September 2006. After CRT for right neck lymph node recurrence, the patient had been followed until April 2008, when the patient suddenly developed upper abdominal pain and visited the hospital's emergency room. CT confirmed the patient having ileus due to a diaphragmatic hernia, and emergency surgery was performed. Intraoperative findings included : the esophageal hiatus that had enlarged during the previous surgery served as a hernia orifice ; and the transverse colon and the small intestine prolapsed into the left thoracic cavity. No clear signs of necrosis were seen with them, they were not dissected, and the esophageal hiatus was ligated. Although a diaphragmatic hernia following esophageal cancer surgery is rare, it is a grave complication. In the present patient, the diaphragmatic hernia occurred because the esophageal hiatus had enlarged during surgery, and endoscopic surgery resulted in minimal adhesion to the abdominal cavity.
