Severe complication of hiatal hernia with gastric and esophageal necrosis
Acute total gastrectomy with esophagojejunoanastomosis via right-sided thoracotomy
Simultaneous resection of multiple jejunal diverticula present
Introduction: In this case report we describe the surgical treatment of an incarcerated bulky mixed hiatal hernia with gastric necrosis, where the only treatment was extensive surgical resection of the stomach. The procedure included resection of the jejunum containing multiple jejunal diverticula.
Case presentation: The patient was examined for acute shortness of breath, chest pain and recurrent vomiting. CT scan showed a bulky mixed hiatal hernia with gastrectasia. The patient was referred for surgical treatment due to acute symptoms. Perioperatively, a mixed hiatal hernia with gastric necrosis due to incarceration of the oral 2/3 of the stomach above the diaphragm was discovered. A total gastrectomy was performed, and due to ischemia of the esophagus, an esophagojejunoanastomosis via right-sided thoracotomy had to be performed. Multiple jejunal diverticula were a surprising perioperative finding and were resected. Postoperatively, the patient was admitted to the ICU. She was discharged to home care in stable condition, fully realimented.
Clinical discussion: Patients with a bulky hiatal hernia are at risk of serious complications if it is incarcerated. Patients with acute symptomatology of the disease are indicated for acute surgical revision, and the surgical procedure is modified according to perioperative findings.
Conclusion: Acute surgical treatment is indicated in patients with symptomatic hiatal hernias where there is a risk of serious complications. The type of surgery is modified according to the actual perioperative findings.
Keywords: Gastric necrosis; Mixed hiatal hernia; Total gastrectomy.