Post-esophagectomy incarcerated hiatal hernia: a surgical emergency

Abstract

A woman is admitted to the emergency department (ED) complaining of acute abdominal pain radiating to the left shoulder, nausea and food intolerance. She had a past history of a minimally invasive McKeown esophagectomy 2 months prior. On clinical examination, the patient had no murmur on the left hemithorax, associated with tachypnea, peripheral oxygen saturation of 83% and epigastric abdominal tenderness. Chest radiography (CXR) revealed a herniated colon within the thoracic cavity with associated distension. Abdominal X-ray (AXR) revealed a nonspecific bowel gas pattern. Thoracic and abdominal computerized tomography (CT) confirmed a transverse colon herniation to the left hemithorax, with a closed loop obstruction, associated with the distension of ileum and the collapse of the descending colon. The patient was referred to the Operating Room where she was submitted to an exploratory laparoscopy, with identification of thoracic herniation of the colon and consequent hernia reduction and cruroplasty. The patient recovered swiftly post-operatively, being discharged home on the sixth day, tolerating oral liquid intake.