We report a relatively rare case of diaphragmatic hernia after esophagectomy without thoractomy. A 62-year-old man was admitted to the hospital because of severe abdominal pain. He had a history of heavy drink-ing and had undergone an esophagectomy about 15 months before admission. Chest X ray, computed tomography (CT), and magnetic resonance imaging (MRI) revealed diaphragmatic hernia and its resultant intestinal obstruction. Emergency surgery was performed. During the surgery, the small intestine and transverse colon were found to be invaginated from an esophageal hiatus, which had expanded into the thorax as a results of the esophagectomy. The small intestine and transverse colon were returned to the abdominal cavity, and a Marlex mesh patch was placed over the expanded esophageal hiatus. In this case, the cause of the diaphragmatic hernia was determined to be repeated high abdominal pressure caused by vomiting after drinking. The recurrent pressure had caused the esophageal hiatus to become fragile to the point of rupture. We conclude that heavy drinking is a risk factor in diaphragmatic hernia after esophagectomy without thoracotomy.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)