Intrathoracic Gastric Perforation within a Hiatal Hernia—A Case Report—

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

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<p>We report a case of intrathoracic gastric perforation within a hiatal hernia in an 82-year-old female patient who underwent successful emergency surgery. The patient with known diagnosis of hiatal hernia was transferred to the emergency department for management of hematemesis. Contrast-enhanced computed tomography revealed gastric perforation in the thoracic cavity with extravasation of contrast medium in the gastric mucosa, and we started emergency laparoscopic surgery. During the operation we detected a perforation (about 2 cm) accompanied by bleeding at the anterior gastric wall in close proximity to the esophagogastric junction. We could not safely dissect the hernia sac owing to adhesions; therefore, we performed laparotomy with left thoracotomy, followed by suture closure and coverage of the perforated area, with suture reduction of the hernia orifice. The patient required intensive postoperative care ; however, oral intake was resumed on postoperative day 15, and she was discharged on postoperative day 28. Gastric perforation within a hiatal hernia is rare but potentially fatal ; prompt surgical intervention is warranted in such cases.</p>

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