開胸開腹食道切除術後に発生した横隔膜ヘルニアの1例

食道癌術後3日目に横行結腸が嵌頓した食道裂孔ヘルニアの1例を経験したので報告する.症例は75歳,女性.2型の胸部中部食道癌に対して右開胸開腹胸部食道亜全摘術,胸腔内食道胃管吻合術を施行したが,術後3日目に突然の呼吸困難を呈した.胸腹部単純X線上,縦隔内に巨大な大腸ガス像を認め,大腸を内容とした食道裂孔ヘルニアと診断し,同日緊急開腹術を施行した.食道裂孔の左側より横行結腸が縦隔内に脱出し,裂孔部で嵌頓していた.ヘルニア内容を腹腔に還納し,食道裂孔の縫縮とメッシュによる補強を行った.術後経過は比較的良好で,術後36日目に軽快転院となった.食道癌術後の食道裂孔ヘルニアはきわめてまれな合併症であるが,その治療として食道裂孔の縫縮およびメッシュによる補強が有用であった.A 75-year-old woman underwent an esophagectomy for thoracic esophageal cancer via right thoracic and abdominal incisions. After resection, the gastric tube was pulled into the posterior mediastinum and intrathoracic esophagogastric anastomosis was performed. Her postoperative course was uneventful until the oxygen saturation decreased to 88% along with the sudden onset of dyspnea on the third postoperative day. A plain chest X-ray demonstrated gas extending from the posterior mediastinum to the left lower hemithorax. As a result, a diagnosis of diaphragmatic herniation of large bowel was made and an emergency laparotomy was performed. After reducing the herniated transverse colon, the enlarged esophageal hiatus was repaired with interrupted sutures and a sheet of Merlex mesh. The patient subsequently recovered well and was discharged on the 36th postoperative day

開胸開腹食道切除術後に発生した横隔膜ヘルニアの1例

食道癌術後3日目に横行結腸が嵌頓した食道裂孔ヘルニアの1例を経験したので報告する.症例は75歳,女性.2型の胸部中部食道癌に対して右開胸開腹胸部食道亜全摘術,胸腔内食道胃管吻合術を施行したが,術後3日目に突然の呼吸困難を呈した.胸腹部単純X線上,縦隔内に巨大な大腸ガス像を認め,大腸を内容とした食道裂孔ヘルニアと診断し,同日緊急開腹術を施行した.食道裂孔の左側より横行結腸が縦隔内に脱出し,裂孔部で嵌頓していた.ヘルニア内容を腹腔に還納し,食道裂孔の縫縮とメッシュによる補強を行った.術後経過は比較的良好で,術後36日目に軽快転院となった.食道癌術後の食道裂孔ヘルニアはきわめてまれな合併症であるが,その治療として食道裂孔の縫縮およびメッシュによる補強が有用であった.A 75-year-old woman underwent an esophagectomy for thoracic esophageal cancer via right thoracic and abdominal incisions. After resection, the gastric tube was pulled into the posterior mediastinum and intrathoracic esophagogastric anastomosis was performed. Her postoperative course was uneventful until the oxygen saturation decreased to 88% along with the sudden onset of dyspnea on the third postoperative day. A plain chest X-ray demonstrated gas extending from the posterior mediastinum to the left lower hemithorax. As a result, a diagnosis of diaphragmatic herniation of large bowel was made and an emergency laparotomy was performed. After reducing the herniated transverse colon, the enlarged esophageal hiatus was repaired with interrupted sutures and a sheet of Merlex mesh. The patient subsequently recovered well and was discharged on the 36th postoperative day