A Case of Intrathoracic Hernia of Jejunal Pull-up through Retrosternal Space after Subtotal Esophagectomy for Esophageal Cancer

Noriyuki Yamamura, Masaaki Nakahara, Shigeru Imabun, Nobutaka Hatanaka, Tetsuo Kido* and Kazuyasu Nakao

Department of Surgery and Department of Thoracic Surgery*, Osaka Police Hospital

We report a rare case of intrathoracic hernia of jejunal pull-up through the retrosternal space after subtotal esophagectomy for esophageal cancer. A 62-year-old man with a history of distal gastrectomy (Billroth II) for duodenal ulcer perforation underwent subtotal esophagectomy for esophageal cancer after neoadjuvant chemoradiation therapy. Reconstruction was done with the jejunum through the retrosternal space under microsurgery. The postoperative course was uneventful, but he reported vomiting and dysphagia 2 months after surgery. Chest X-ray and computed tomography showed cystic dilation of the jejunum at the right side of the mediastinum. Gastrografin ingestion showed the jejunum to be stretched and twisted due to an intrathoracic hernia of the jejunal pull-up. We resected the jejunum under lower sternotomy and fixed the jejunum to the mediastinum to prevent recurrence of the hernia. The postoperative course was uneventful, but the man died of multiple organ failure after esophageal cancer metastasized 14 months after the first operation.

Key words
intrathoracic hernia, jejunal pull-up, retrosternal reconstruction

Reprint requests
Noriyuki Yamamura Department of Surgery, Osaka University Graduate School of Medicine, E1
2-2 Yamadaoka, Suita, 565-0871 JAPAN

Accepted
September 28, 2005

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