Laparoscopic repair of secondary parahiatal hernia with incarceration of the stomach: a case report

Our plain-English summary of Laparoscopic repair of secondary parahiatal hernia with incarceration of the stomach: a case report, by M. Takemura, K. Mayumi, T. Ikebe, et al (Journal of Medical Case Reports, 2013).

The study

• Authors: M. Takemura, K. Mayumi, T. Ikebe, G. Hamano
• Journal: Journal of Medical Case Reports
• Published: 2013;7:50
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Parahiatal hernia is an extremely rare subtype of hiatal hernia, which in turn is a type of diaphragmatic hernia in adults, and only a few cases have been reported to date. We report the case of a patient who suffered from gastric incarceration through an anatomically separate diaphragmatic defect, immediately lateral to a structurally normal esophageal hiatus, that developed after treatment of a malignant mesothelioma.

Case Presentation: A 70-year-old Japanese man, who had undergone treatment for a left malignant pleural mesothelioma a year ago at another hospital, was referred to our institution following a 4-day history of epigastric pain. Esophagogastroscopy demonstrated a normal esophagogastric junction, with remarkable stenosis and active gastric ulcer of the gastric body. Histopathological examination of the gastric biopsy specimen confirmed a gastric ulcer. Furthermore, computed tomography revealed a large fluid-filled structure in the retrocardiac space. On the basis of preoperative data, we decided to attempt laparoscopic repair for the gastric volvulus. During surgery, gastric and omental herniation was observed within a peritoneal lined defect immediately lateral to the esophageal hiatus. Dissection near the esophageal hiatus revealed a discrete extrahiatal defect 3cm in diameter immediately adjacent to the left crus of the diaphragm. The parahiatal defect was closed using interrupted nonabsorbable heavy suture. The patient's postoperative course was uneventful, and anastomotic leakage was not observed at postoperative barium swallowing.

Conclusions: Although preoperative diagnosis of parahiatal hernia is difficult, a laparoscopic approach can be a useful therapeutic procedure not only for paraesophageal hernia but also for parahiatal hernia.

In plain English

This is a case report about one patient, a 70-year-old Japanese man treated over the previous year at another hospital for a left malignant pleural mesothelioma. The article does not mention asbestos. He arrived with four days of upper abdominal pain, difficulty swallowing and severe vomiting. Endoscopy found narrowing of the stomach and an active stomach ulcer, and a CT scan showed a large fluid-filled structure behind the heart. During laparoscopic (keyhole) surgery, part of the stomach and omentum (abdominal fatty tissue) was found trapped in a 3 cm hole in the diaphragm. The hole was next to, but separate from, the normal opening for the esophagus. This is called a parahiatal hernia. The hole was closed with stitches. A tear in the stomach that occurred during surgery was treated by removing the upper stomach. He recovered without complications and left hospital 29 days after surgery. The authors suggested the hernia may have been related to the mesothelioma or a pleural biopsy. They concluded that laparoscopy can be useful for this kind of hernia.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 70-year-old Japanese man referred to the authors' institution (Gohshi Hospital, Amagasaki, Hyogo, Japan) with a 4-day history of epigastric pain. He had been treated at another hospital for the past year for a left malignant pleural mesothelioma. The date of admission is not given.
• Exposure: No asbestos or other fiber exposure is reported. The hernia developed after treatment of a left malignant pleural mesothelioma (type of treatment not specified).
• Main results:
  • Endoscopy showed a normal esophagogastric junction, marked narrowing of the gastric body and an active ulcer in the middle gastric body. A biopsy confirmed a gastric ulcer.
  • Computed tomography showed a large fluid-filled structure in the retrocardiac space, with mild left pleural effusion and atelectasis.
  • A chest X-ray before mesothelioma treatment showed no elevation of the diaphragm. At this admission, the left hemidiaphragm was elevated.
  • At surgery, the stomach and omentum had herniated through a separate 3 cm defect immediately adjacent to the left crus of the diaphragm, next to a normal esophageal hiatus.
  • The trapped top of the gastric fundus was friable but not necrotic.
  • A large full-thickness tear in the gastric fornix occurred during manipulation, and a proximal gastrectomy was performed for it.
  • Surgery took 215 minutes with minimal blood loss.
  • No anastomotic leakage was seen on postoperative barium swallow. The patient resumed eating 5 days after surgery and was discharged 29 days after surgery.
  • The authors hypothesized that the mesothelioma developed at a fragile site of the left diaphragm, which may have caused the hernia opening. They also suggested that a pleural biopsy for mesothelioma may create a hernia opening. They diagnosed a secondary (or iatrogenic) parahiatal hernia.
• The authors' conclusion: The authors concluded that, although parahiatal hernia is difficult to diagnose before surgery, a laparoscopic approach can be a useful treatment for parahiatal hernia as well as paraesophageal hernia.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Biopsy, Diaphragm.

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