Diaphragmatic hernia after esophagectomy for esophageal malignancy

Diaphragmatic hernia (DH) is an uncommon complication after esophagectomy, with <150 cases reported in the literature. The objective of our study was to determine the incidence and clinical presentation of this condition and to describe the prospective recognition of this finding in radiologic reports.

Cross-sectional imaging studies of all patients who underwent an esophagectomy between January 2001 and December 2007 at a single tertiary care center were retrospectively reviewed by 2 radiologists who were blinded to the clinical information and radiologic reports. Patients with DH were identified and their demographics, characteristics of hernia, and patient outcome were recorded. Radiology reports issued at the time of study were reviewed independently by a third reviewer to assess whether the hernia was prospectively reported.

A total of 458 patients underwent esophagectomy during the study time period, of whom 440 patients were eligible to be included in the study. Forty-four patients developed postesophagectomy DH. Thirty-six patients with DH were asymptomatic, whereas 8 had hernia-related symptoms. Only 7 cases were prospectively reported by the radiologists. Of the 37 cases not reported by the radiologists, 6 required surgical intervention during the follow-up.

Postesophagectomy DH is difficult to diagnose clinically but is usually apparent on cross-sectional imaging. Some asymptomatic patients may develop hernia-related complications, which significantly increases the mortality rate. Hence, radiologists need to be aware of this rare postoperative complication and should report this finding so that affected patients can be optimally managed by surgeons.