Case of Delayed Transhiatal Pancreatic Herniation After Esophagectomy

Abstract

Transhiatal herniation of the pancreas is a rare phenomenon, especially after esophagectomy. We present a 66-year-old White man who developed a 15-cm transhiatal hernia containing nonobstructed small bowel and pancreas approximately 23 years after an open transhiatal esophagectomy for esophageal adenocarcinoma. He experienced frequent nausea and regurgitation and slept upright in a chair for comfort for 8 years postoperatively until subsequent workup discovered an incarcerated supraumbilical incisional hernia containing omentum, which was repaired laparoscopically. Afterward, he remained asymptomatic for 15 years until he presented to our clinic with complaints of acid reflux.Physical examination and vital signs were unremarkable aside from mild epigastric tenderness on abdominal examination. Amylase was 58 m/L, and lipase was 30 m/L. Thoracic, abdominal, and pelvic computed tomography demonstrated a hiatal hernia involving the gastric pull-through extending into the lower inferior mediastinum along with the pancreas and nonobstructed loops of small bowel Figure 1. Pancreas visualized in mediastinum inferior to gastric pull-through.