Hiatal Hernia as a Total Gastrectomy Complication.
BACKGROUND
According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy.


METHODS
A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery.


CONCLUSIONS
Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.
Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil.
Bruna do Nascimento
Bdo N
Santos
Surgery Department of Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil; Oncologic Surgery Department of Hospital Israelita Albert Einstein, São Paulo, Brazil; Centro Oncológico Antônio Ermírio de Moraes, São Paulo, Brazil; Surgery Department of Hospital Israelita Albert Einstein, São Paulo, Brazil.
Marcos Belotto
MB
de Oliveira
Centro Oncológico Antônio Ermírio de Moraes, São Paulo, Brazil.
Renata D'Alpino
RD
Peixoto
Gastric cancer; Hiatal hernia following gastrectomy; Total gastrectomy