Laparotomy and Thoracotomy for Gastric Necrosis Due to Incarcerated Esophageal Hiatal Hernia

Abstract

An 84-year-old woman was referred to our hospital for poor oral intake. Gastrointestinal endoscopy showed necrosis of gastric mucosa. CT showed the proximal stomach migrated into the left thoracic cavity via the esophageal hiatal hernia. The preoperative diagnosis was gastric necrosis due to incarcerated esophageal hiatal hernia, and emergency surgery was performed. On laparotomy, we found the incarcerated esophageal hiatal hernia of the stomach. The proximal stomach became necrotic and the inflammation spread to the lower esophagus, so we performed proximal gastrectomy and lower esophagectomy, and intrathoracic end-to-end anastomosis using gastric tube by laparotomy and right thoracotomy. Gastric necrosis due to esophageal hiatal hernia is an unusual case. A case which needs proximal gastrectomy and lower esophagectomy with laparotomy and thoracotomy is rare. We saved the life of an over-eighty-year-old patient, but she suffered from remaining complications such as anastomotic leakage.