Intrathoracic hernia of a retrosternal colonic graft after esophagectomy: Report of a case

Takayama, Tomoyoshi; Wakatsuki, Kohei; Matsumoto, Sohei; Enomoto, Koji; Tanaka, Tetsuya; Migita, Kazuhiro; Nakajima, Yoshiyuki

doi:10.1007/s00595-010-4501-z

Cited by 9 publications

(9 citation statements)

References 6 publications

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“…However, most sites of internal hernias in Roux-Y reconstruction after total gastrectomy include a transverse mesocolon defect, such as Petersen's space and a jejunojejunostomy defect [ 6 ]. With regard to case reports of intrathoracic hernia, there are a few reports after a procedure for esophageal cancer [ 8 , 11 ], but there are no reports after total gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Intrathoracic Hernia after Total Gastrectomy

Tashiro

Murakami

Otsuka

et al. 2016

Case Rep Gastroenterol

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Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.

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Section: Discussionmentioning

confidence: 99%

Intrathoracic Hernia after Total Gastrectomy

Tashiro

Murakami

Otsuka

et al. 2016

Case Rep Gastroenterol

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“…To the best of our knowledge, this is the first report to document such an event. Only a few case reports have documented intrathoracic herniation of reconstructed organs [5,9] . For example, Takayama et al [5] reported a case of an intrathoracic herniation of a retrosternal colonic graft following esophagectomy, which presented with progressive dysphagia approximately 1 year following esophagectomy, despite an uneventful clinical course in the early postoperative period.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few case reports have documented intrathoracic herniation of reconstructed organs [5,9] . For example, Takayama et al [5] reported a case of an intrathoracic herniation of a retrosternal colonic graft following esophagectomy, which presented with progressive dysphagia approximately 1 year following esophagectomy, despite an uneventful clinical course in the early postoperative period. In this earlier case, the authors performed left thoracotomy and laparotomy, which revealed that the reconstructed colon had herniated into the left thoracic cavity through a large defect in the left mediastinal pleura.…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Intrathoracic Herniation of Gastric Tube Pull-Up via the Retrosternal Route following Esophagectomy

Uemura

Kawakami

et al. 2017

Dig Surg

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Background: Intrathoracic herniation of gastric tube (IHGT) pull-up via the retrosternal route is a rare complication following esophagectomy, which is caused due to an injury in the parietal pleura during a blunt dissection of the retrosternal space. However, little is known regarding the clinical impact of IHGT pull-up via the retrosternal route. Patients and Methods: Clinical data of 231 patients receiving gastric tube reconstruction via the retrosternal route following esophagectomy were collected from medical charts. Results: Of the 231 patients, 19 (8%) developed IHGT. Vocal cord palsy, particularly with delayed onset, developed at a significantly high frequency in the group of patients with IHGT. There were no significant differences in the frequency of other surgical complications. Conclusion: This is the first report to examine the clinical impact of IHGT pull-up via the retrosternal route. Vocal cord palsy, particularly with delayed onset, developed in the group of patients with IHGT. Therefore, when reconstruction is performed via the retrosternal route, it is very important that blunt and blind dissection of the retrosternal space be performed with extreme care to prevent pleural injury.

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“…The retrosternal route is one reconstruction route that may be used after esophagectomy. Intrathoracic herniation of reconstructed organs was reported by Takayama et al [3] and Uemura et al [4], but no reports have described the incarceration of intestinal tissues other than reconstructed organs in the retrosternal space and thoracic cavity. We herein report three cases of internal hernia to the retrosternal space (hereafter called retrosternal hernia) after MIE.…”

Section: Introductionmentioning

confidence: 99%

Internal hernia to the retrosternal space is a rare complication after minimally invasive esophagectomy: three case reports

et al. 2019

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Background Minimally invasive esophagectomy is considered a beneficial approach to esophageal cancer, although a hiatal hernia occurs more frequently in this approach than in open esophagectomy with reconstruction via the mediastinal route. Development of an internal hernia to the retrosternal space is not a recognized complication of reconstruction via the retrosternal route after esophagectomy. We herein report three cases of the development of an internal hernia to the retrosternal space after minimally invasive esophagectomy. Case presentation Thoracolaparoscopic esophagectomy with cervical anastomosis by retrosternal route reconstruction was performed in all three cases. All patients were men ranging in age from 60 to 80 years. Two patients had abdominal pain, and one had experienced syncope. All patients were diagnosed by computed tomography with an internal hernia to the retrosternal space and thoracic cavity (retrosternal hernia) without ischemic change to the incarcerated intestine. Two patients received medical therapy to relieve their intra-abdominal pressure, which allowed for a successful reduction of the intestine into the abdomen. Open laparotomy was performed to repair the hernia in the third patient. After reducing the intestine into the abdomen, reefing of the retrosternal orifice was performed, and the gastric conduit was anchored to the abdominal wall. No relapse occurred in three cases throughout follow-up. Conclusion Hiatal hernia is a well-recognized complication after minimally invasive esophagectomy; however, retrosternal hernia is a rare complication following this procedure. Based on the present report, if no ischemic change is present in the herniated intestine, two types of potentially curative treatments are available: medical or surgical. As minimally invasive esophagectomy is performed more frequently, retrosternal hernia may become an increasingly more common complication in the near future.

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Intrathoracic hernia of a retrosternal colonic graft after esophagectomy: Report of a case

Cited by 9 publications

References 6 publications

Intrathoracic Hernia after Total Gastrectomy

Intrathoracic Hernia after Total Gastrectomy

Clinical Impact of Intrathoracic Herniation of Gastric Tube Pull-Up via the Retrosternal Route following Esophagectomy

Internal hernia to the retrosternal space is a rare complication after minimally invasive esophagectomy: three case reports

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