A Case of Gastric Perforation Occurred in Esophageal Hiatal Hernia

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  • 食道裂孔ヘルニア内で発症した胃穿孔の1例
  • 症例 食道裂孔ヘルニア内で発症した胃穿孔の1例
  • ショウレイ ショクドウレツコウ ヘルニア ナイ デ ハッショウ シタ イ センコウ ノ 1レイ

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We present a case of gastric perforation occurred in an esophageal hiatal hernia treated by emergency operation.<BR>A 78-year-old woman was brought into our hospital by ambulance because of hematemesis. An esophagogastroduodenoscopy revealed multiple longitudinal ulcers at the esophagogastric junction. A CT scan showed mediastinal emphysema. The patient was emergently operated on with a suspected diagnosis of spontaneous rupture of the esophagus. Since pleural effusion was few and the mediastinal emphysema was localized in the inferior mediastinum, we selected the transhiatal approach. Median incision was made in the upper abdomen and we reached the esophageal hiatus site, where the esophageal hiatal hernia was seen. We confirmed a laceration about 5 cm in length at the cardiac part within the hiatal hernia, through which the gastric tube had exposed. Following simple closure of the ulcerative perforation, we performed closure of the esophageal hiatum, followed by plication suture of the fundus of the stomach to the anterior wall of the anastomosis and the diaphragmatic crus to make cardioplasty. Transgastric enterostomy was placed. After intraoperative confirmation of the closure of the sutured site by using an endoscopy, the operation was completed. A contrast study performed on the 8th postoperative day (POD) revealed suture failure, for which fistulation by drain management was planned and endoscopic closure of the anastomosis was done on the 23rd POD. Thereafter the patient started oral ingestion from the 40th POD and was transferred to another hospital on the 63rd POD.

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