左胸腔鏡下下縦隔腫瘍摘出直後に発症した食道裂孔ヘルニア嵌頓の1例

A case of incarcerated esophageal hiatal hernia directly following the left thoracoscopic excision of a lower mediastinal tumor

◆要旨：患者は50歳代の男性で，下縦隔腫瘍に対し，左胸腔鏡下下縦隔腫瘍摘出術を施行した．術後1日目より頻回の嘔吐があった．術後2日目に食道裂孔ヘルニア（混合型）を認め，当科紹介となった．術後7日目に腹腔鏡下食道裂孔ヘルニア修復術を施行した．嵌頓した胃上部を腹腔内へ牽引・整復し，食道裂孔を縫縮しメッシュによる補強後，噴門形成術（Nissen法）を併施した．術後経過良好で，食道裂孔ヘルニア修復術後12日目に退院した．術後食道裂孔ヘルニアは，胸腔側・腹腔側のいずれの手術においても，食道裂孔周囲を扱う手術において起こりうる術後合併症である．術前から食道裂孔ヘルニアの発生を念頭におき，手術に臨むべきである．

　A man in his fifties was diagnosed as having a lower mediastinal tumor. He underwent left thoracoscopic lower mediastinal tumor excision. On postoperative day 1, he had frequent vomiting. On postoperative day 2, esophageal hiatal hernia was observed, and he was referred to our department. On postoperative day 7, laparoscopic esophageal hiatal hernia repair was performed. The incarcerated hernia was reduced into the abdominal cavity and repaired. The esophageal hiatus was sutured and repaired with a biological mesh. Thereafter, the Nissen fundoplication procedure was performed. He recovered well and was discharged 12 days after the repair surgery. Esophageal hiatal hernia is a postoperative complication that may occur in either thoracic or abdominal procedures when the surgery is performed on the areas around the esophageal hiatus. When such a surgery is performed, it is necessary to anticipate the development of esophageal hiatal hernia beforehand.