Hiatal hernia following total gastrectomy with Roux-en-Y reconstruction

Area of Science:

• Gastroenterology
• Surgical Oncology
• Thoracic Surgery

Background:

• Total gastrectomy is a major surgical procedure for advanced gastric cancer.
• Post-gastrectomy complications, though infrequent, require careful management.
• Hiatal hernias are an exceptionally rare post-gastrectomy complication.

Observation:

• A 44-year-old male developed dyspnea and chest pain two days post-total gastrectomy, lower esophagectomy, and splenectomy.
• Imaging revealed a large hiatal hernia containing the transverse colon and small intestine protruding into the right thorax.
• The patient underwent surgical repair of the hiatal defect via laparotomy.

Findings:

• The hiatal defect was repaired by direct suturing.
• The patient experienced post-operative complications including anastomotic leakage and right pyothorax.
• Despite complications, the patient ultimately recovered.

Implications:

• This case underscores the possibility of rare hiatal hernias following complex gastric cancer surgery.
• Prompt diagnosis and surgical intervention are crucial for managing such rare complications.
• Further literature review is needed to understand the etiology and optimal management of post-gastrectomy hiatal hernias.