Giant incarcerated diaphragmatic hernia post-esophagectomy (McKeown) with severe dilatation of gastric esophagoplasty.

Abstract

A 58-year-old male with a history of triple-approach laparoscopic esophagectomy (McKeown) due to distal esophageal adenocarcinoma (ypT3N1M0), who reported 24 h of intense epigastralgia associated with vomiting and dyspnea. Thoracoabdominal CT scan (Fig. 1) revealed a left diaphragmatic hernia measuring 7.5 cm in diameter containing the omentum, intestinal loops and transverse colon (H), causing notable distention of the gastroplasty (G). Urgent laparoscopic surgery was indicated (Fig. 2), with hernia reduction (250 cm of small intestine, transverse colon and gastric antrum) and closure of the pillars with ETHIBOND EXCEL1 interrupted stitches coated with polybutilate and gastropexy. Postoperative patient progress was good; the patient presented no complications and was discharged on the 5th day. c i r e s p . 2 0 2 0 ; 9 8 ( 2 ) : 9 9