title: Intrathoracic Hernia after Total Gastrectomy.
abstract: Intrathoracic hernias after total gastrectomy are rare. We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected with the abdominal cavity. A pleural defect was not repaired. Two days after the operation, the patient was suspected of having intrathoracic hernia by chest X-rays. Computed tomography showed that the transverse colon and Roux limb were incarcerated in the left thoracic cavity. He was diagnosed with intrathoracic hernia, and emergency reduction and repair were performed. Operative findings showed that the Roux limb and transverse colon were incarcerated in the thoracic cavity. After reduction, the orifice of the hernia was closed by suturing the crus of the diaphragm with the ligament of the jejunum and omentum. After the second operation, he experienced anastomotic leakage and left pyothorax. Anastomotic leakage was improved with conservative therapy and he was discharged 76 days after the second operation.
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Tashiro
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Murakami
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Motegi
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Date
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tomotake
authors.initials: T
authors.lastname: Ariyoshi
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Goto
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Kimiyasu
authors.initials: K
authors.lastname: Yamazaki
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fujimori
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of General and Gastroenterological Surgery, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoki
keywords: Gastrectomy; Intrathoracic hernia; Laparoscopic surgery; Liver cirrhosis