A rare clinical observation of transthoracic correction of complicated diaphragm hernia after gastrectomy

The results of treatment of late strangulated hernia of the esophageal opening of the diaphragm, which occurred 18 months after transabdominal extended gastrectomy for cardioesophageal cancer, has been presented. Clinically, the onset of the complication was manifested by a combination of abdominal pain syndrome and shortness of breath in the absence of pronounced peritoneal symptoms. Multispiral computed tomography of the chest and abdomen revealed migration of small intestinal loops into the left pleural cavity and lung compression. An emergency transthoracic intervention was performed: lateral thoracotomy, revision of the posterior inferior mediastinum, repositioning of the small intestine into the abdominal cavity and suturing of the diaphragmatic defect with a nonabsorbable thread, which ensured a favorable course of the postoperative period and the absence of relapse during a 4-year follow-up. The presented observation emphasizes the need for high alertness regarding postoperative diaphragmatic hernias in cancer patients with a history of extensive interventions and chemoradiation therapy, and also demonstrates the validity of choosing a transthoracic approach in the context of previous extensive abdominal surgery.

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