Abstract
A 71-year-old male who underwent subtotal esophagectomy with retromediastinal gastric tube reconstruction for thoracic esophageal cancer was seen at our hospital because of nausea about 9 months after the operation. A chest computed tomography (CT) scan disclosed intestine prolapse into the left thoracic cavity. He was diagnosed with bowel obstruction due to a diaphragmatic hernia and an emergency operation was performed. Intraoperative findings included enlargement of the esophageal hiatus during the previous surgery, which behaved as a hernia orifice ; and through the orifice a small intestine had prolapsed into the left thoracic cavity and entirely necrotized. The about 260-cm long affected intestine was dissected while the esophageal hiatus was closed. Nausea appeared again after another 6 months. Chest X-ray detected bowel gas in the left thoracic cavity and another emergency surgery was conducted for recurrence of the diaphragmatic hernia. The esophageal hiatus had no adhesion, and the transverse colon had prolapsed into the left thoracic cavity. No clear signs of necrosis were observed. The esophageal hiatus was closed with non-absorbable suture and covered with the greater omentum. Diaphragmatic hernia after esophageal cancer surgery is a rare but serious complication because delayed diagnosis can cause bowel necrosis. Such a complication had recurred in this case. We here present this case, together with a review of the literature from various standpoints including probable causes of the recurrence.
