Gastric perforation secondary to an incarcerated paraesophageal hernia
Abstract Background Paraesophageal hernias are usually asymptomatic; however, they can cause serious complications such as necrosis or incarceration-induced perforation. Necrosis usually occurs in the incarcerated portion of the hernia. Here, we report the case of a patient with gastric necrosis sec...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Japan Surgical Society
2019-06-01
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| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40792-019-0653-2 |
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| Summary: | Abstract Background Paraesophageal hernias are usually asymptomatic; however, they can cause serious complications such as necrosis or incarceration-induced perforation. Necrosis usually occurs in the incarcerated portion of the hernia. Here, we report the case of a patient with gastric necrosis secondary to an incarcerated paraesophageal hernia in which the necrotic lesion was outside the hernia sac. Case presentation A 91-year-old woman presented with severe abdominal pain and vomiting. A physical examination showed hypotension and a diffusely tender and rigid abdomen. Computed tomography showed a paraesophageal hernia, massive ascites, and free air around the stomach. A laparotomy was performed to treat the upper gastrointestinal perforation. The stomach was incarcerated within the paraesophageal hernia sac. After reducing the stomach, we identified a large perforation on the posterior wall of the gastric fundus. Full-thickness necrosis involving part of the stomach necessitated total gastrectomy. She remained physiologically unstable and her condition deteriorated; she died 2 days postoperatively. Conclusions A hiatal hernia can be associated with an ischemic gastric perforation outside the hernia sac. |
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| ISSN: | 2198-7793 |