A Case of Incarcerated Hiatal Hernia Developed after Esophagectomy with Retrosternal Reconstruction for Esophageal Cancer

Abstract

The patient was an 83-year-old man who underwent curative esophagectomy with retrosternal gastric tube reconstruction by the transhiatal non-thoracic approach for esophageal cancer a year earlier. He had been followed up in a relapse-free condition. He presented with feeling of fatigue and abdominal pain, and was transferred to our hospital with a suspected diagnosis of incarcerated hiatal hernia. An emergency operation was performed because of his worsening respiratory status. Intraoperative findings showed that the transverse colon had prolapsed into the right thoracic cavity through the hiatus. Although the incarcerated hernia was released, partial resection of the transverse colon and colostomy were performed because an ischemic change was identified in the colon. The enlarged hiatus was repaired by sutures. Sometimes we encounter cases of hiatal hernia after esophagectomy, in which the reconstruction had predominantly been performed via posterior mediastinal route and extremely rarely done via retrosternal route. The mechanisms of the onset of hiatal hernia after retrosternal reconstruction are predicted to be a vulnerability of the hiatal tissue and smallness of the lateral segment of the liver. Intraoperative findings showed the hiatus to be narrow and strong but not to be covered by the lateral segment. The decrease of adhesions in the thoracic or abdominal cavity by transhiatal non-thoracic approach or HALS technique might also contribute to the risk of causing hiatal hernia after esophagectomy.