Dysphagia Resulting from Pleural Herniation of the Interposed Jejunum after Total Gastrectomy and Jejunal Interposition

Masato Matsuzaki, Harushi Udagawa, Masaki Ueno, Shinji Mine, Takashi Fukuda, Yoshihiro Kinoshita, Kenji Tutumi, Toshihito Sawada and Goroh Watanabe

Department of Gastrointestinal Surgery, Toranomon Hospital

In 1985 a 64-year-old man underwent total gastrectomy, lower esophagectomy, distal pancreatectomy, and splenectomy with jejunal interposition approached by a left thoracoabdominal incision for gastric cancer at the cardia. Although his clinical course was uneventful, dysphagia and postprandial vomiting began in March 2001 and gradually worsened. Gastrofiberscopy showed marked tortuosity but no stenosis in the interposed jejunum. He was admitted for further examination and found in an upper gastro intestinal series to have stenosis and saccular extension of the interposed jejunum. He underwent surgery based on a diagnosis of diverticulum of the interposed jejunum and intrathoracic herniation. Operative findings showed that the interposed jejunum had prolapsed in to the right thoracic cavity through a right mediastinal pleural defect. The pleural defect was closed by flat Marlex mesh and the interposed jejunum fixed to the diaphragm. After surgery his symptoms disappeared and oral intake increased. Only one case of postoperative pleural herniation of the intestine has, to our knowledge, been reported in the literature. It is thus important to add to the differential diagnosis, if dysphagia appears after gastric or esophagial surgery with intramediastinal reconstruction.

Key words
pleural hernia, total gastrectomy, jejunal interposition

Reprint requests
Masato Matsuzaki Department of Gastrointestinal Surgery, Toranomon Hospital 2-2-2 Toranomon, Minato, Tokyo 105-8470, JAPAN

Accepted
May 27, 2003

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