Massive pneumoperitoneum after esophagectomy.
A 79-year-old man presented for routine follow-up computed tomography after esophagectomy (reconstruction had been done by intrathoracic esophagogastrostomy) had been performed 18 months earlier for thoracic esophageal cancer (pT2, pN1, M0, stage IIB according to International Union Against Cancer classification). Although he had no symptoms, plain abdominal radiography and computed tomography revealed massive pneumoperitoneum and a small right pneumothorax. On the day after admission, upper gastrointestinal endoscopy showed no ulcers or strictures of the remnant esophagus, gastric tube, and duodenum. Air was released by spontaneous rupture of blebs in the right lung, after which it passed through the esophageal hiatus, which had been opened at the time of esophagectomy, and accumulated in the abdominal cavity. The origin of the gas can be understood from the postoperative anatomic changes, as can the mechanism of air retention in the abdominal cavity. When a patient has a history of operation, accurate understanding of operative procedure and postoperative anatomic change may provide a clue to appropriate diagnosis.
Murata
Yoshihiko
Y
Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Japan. pochihiko01t@yahoo.co.jp
Miyata
Kanji
K
Yuasa
Norihiro
N
Takeuchi
Eiji
E
Goto
Yasutomo
Y
Miyake
Hideo
H
Nagai
Hidemasa
H
Kobayashi
Yoichiro
Y
D000368:Aged; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology*; D011860:Radiography, Abdominal / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*