A Case Report of Hiatal Hernia Developed One Year after Esophagectomy with Posterior Mediastinal Reconstruction for Esophageal Cancer

Abstract

A 74-year-old man underwent right transthoracic esophagectomy with 3-field lymph node dissection and reconstruction using a gastric tube in posterior mediastinal route for esophageal cancer in September 2019. One year after surgery, he was brought into a local hospital for acute abdomen. Computed tomography (CT) showed prolapse of the small intestine into the right thoracic cavity. The patient was referred to our hospital with a diagnosis of postoperative diaphragmatic hernia through the esophageal hiatus. As abdominal pain was temporarily relieved, conservative therapy was performed. However, on the 12th day after admission, the patient had recurrent abdominal pain, and emergency surgery was performed because a hiatal hernia was suspected on a thoracoabdominal contrast-enhanced CT scan. After surgery, he had a surgical site infection (dehiscence) and required re-suture of the abdominal wall, but he was discharged on day 36 after re-suture. Esophageal hiatal hernia occurring in the reconstructive route after esophagectomy is relatively rare. The escape of the gastric conduit into the right thoracic cavity may result in a hiatal hernia. It was thought to be necessary for surgical treatment for postoperative hiatal hernia because it would not improve with conservative therapy.