A Case of Esophageal Hiatal Hernia with Incarcerated Transverse Colon

Yukihiro Itabashi¹⁾²⁾, Toshiaki Baba¹⁾²⁾, Satoru Kato¹⁾ and Mutsuo Sasaki²⁾

Department of Surgery, Kizukuri Adult Disease Medical Center¹⁾
Department of Second Surgery, Hirosaki University School of Medicine²⁾

A 67-year-old woman was brought to the hospital by ambulance because of recurrent vomiting and emaciation. Parenteral nutrition immediately was instituted to treat dehydration and hyponutrition. A plain posteroanterior film and CT scan of the chest revealed bowel gas in the posterior mediastinum. Subsequent colonoscopy demonstrated the bowel in the posterior mediastinum to be the transverse colon. When she consumed a meal, symptoms of intestinal obstruction occurred and led to a diagnosis of diaphragmatic hernia with incarcerated transverse colon. An approximately 30 cm segment of the transverse colon had herniated superiorly into a sac that passed through an abnormally wide esophageal hiatus. The gastroesophageal junction remained fixed below the diaphragm, and the stomach remained in its proper position. The portion of the transverse colon in the sac was easily reduced into the abdominal cavity, leaving a 5 cm hiatal orifice that extended to the right. Since the edge of the orifice was hard and unyielding, approximation of the defect with sutures was abandoned. Instead, omentopexy was performed to fill the hiatal sac with a portion of the greater omentum and to fix it with sutures to the edge of the orifice. Recovery was uneventful except for postoperative pneumonia. A thin barium meal demonstrated the stomach and transverse colon in their proper position. The patient was discharged on the 34th postoperative day. This is the first report of omentopexy as a means of repairing esophageal hiatal hernia.

Key words
esophageal hiatal hernia, incarcerated transverse colon, omentopexy

Reprint requests
Yukihiro Itabashi Department of Second Surgery, Hirosaki University School of Medicine
5 Zaifu-cho, Hirosaki, 036-8562 JAPAN

Accepted
November 26, 2003

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