Transverse colon perforation in the mediastinum after esophagectomy: a case report

Abstract

Background: While anastomotic leakage, recurrent laryngeal nerve paralysis, and pneumonia are well-known complications of esophagectomy, the incidence of hiatal hernia after esophagectomy for carcinoma has been reported to only be between 0.6 and 10%. We report a very rare case of hiatal hernia with transverse colon rupture in the mediastinum after esophagectomy in a 65-year-old woman. Case presentation: The patient underwent definitive chemoradiotherapy for clinical stage IIA esophageal squamous cell carcinoma and salvage esophagectomy with gastric tube reconstruction through a posterior mediastinum route for residual carcinoma. Three years after the initial surgery, two metastatic nodules in the lateral and posterior segments of the liver were detected on follow-up CT and were treated with oral anticancer drugs. After 6 months, the patient was readmitted for anorexia. Upon admission, computed tomography revealed an ileus caused by a hiatal hernia. Emergent operative repair was performed; an incarcerated herniation of the transverse colon was perforated in the mediastinum, and partial transverse colon resection and colostomy were performed. Intensive care was required to control septic shock after surgery, and the patient was discharged on the 53rd postoperative day. Conclusions: Cases of hiatal hernia with digestive tract prolapsing into the mediastinum after esophagectomy with reconstruction through posterior mediastinum are rare but potentially life-threatening complications.

A rare and severe complication after minimally invasive esophagectomy: First case of a left-sided tension pneumothorax caused by intrathoracic perforation of the herniated transverse colon. Case report and literature review

“…Subsequently, the herniated colon perforated intrathoracically and a left-sided tension pneumothorax developed in this patient. To our knowledge, only one other case characterized by such a herniation with closed-loop obstruction and intrathoracic perforation has been reported so far; however, that one differs from ours in site of the perforation, which was located in the mediastinum without pleural involvement or pneumothorax (3). Furthermore, we provide a review of the literature dealing with such intrathoracic colonic herniations, both spontaneously and in a post esophagectomy setting.…”

“…Our patient had surgery in June of 2020, and a small intrathoracic hiatal hernia of the transverse colon and omentum at the base of the left hemithorax was retrospectively already seen in the CT imaging immediately after surgery (Figure 3), and the hernia showed continuous progression at the follow-up CT examinations. Small asymptomatic hernias can be controlled with a wait-and-see approach as well as treated surgically at an early stage (3,11). However, symptomatic hernias are known to be associated with a high mortality of up to 20% (1, 2).…”

Post-Esophagectomy Hiatal Hernia: A Case Series

“…Complicated hiatal hernias are associated with high rates of mortality. There has been only one reported case of the successful management of prolapsed transverse colon rupture after esophagectomy, by Konno-Kumagai et al [ 13 ].…”