[A Case of Repeated Bowel Obstruction Due to Diaphragmatic Hernia after Surgery for Esophagogastric Junction Cancer].

ABSTRACT

The patient was a 79-year-old man who underwent robot-assisted gastrectomy for esophagogastric junction cancer. pT4aN1M0, pStage ⅢA. Nine months after surgery, he had emergency visit to the hospital due to abdominal pain and vomiting, and contrast CT scan showed a small intestine with poor contrast effect above the left diaphragm. He was diagnosed as a diaphragmatic hernia with small intestinal strangulation and underwent emergency surgery. Under laparotomy, 2 fb hernia orifice were observed on the ventral side of the esophageal hiatus, and a 50 cm jejunum was incarcerated and became necrotic. A partial jejunectomy was performed, and the esophageal hiatus was closed by suturing the stomach with 3-0 absorbable suture. He was discharged from the hospital with good postoperative course. But one month after the operation, the patient was seen in the hospital again with abdominal pain. Under laparotomy, it was found that one suture was dropped off the esophageal hiatus at the previous surgery, and a 100 cm jejunum was incarcerated, which was not necrotic. The hiatal hernia was closed by suturing the stomach and the hiatal hernia with 3-0 non-absorbable suture. Diaphragmatic hernia is a rare late complication of esophagogastric junction cancer.