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Acute Intrathoracic Incarceration of the Stomach After Laparoscopic Nissen Fundoplication

Idani, Hitoshi MD; Narusue, Mitsuo MD; Kin, Hitoshi MD; Uda, Kenji MD; Muro, Masahiko MD; Kaneko, Akihisa MD; Sasaki, Hiroshi MD; Watanabe, Kazuhiko MD

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: April 2000 - Volume 10 - Issue 2 - p 99-102
Brief Clinical Reports

A rare case of paraesophageal hernia with complete intrathoracic incarceration of the stomach after laparoscopic Nissen fundoplication is described. An 85-year-old woman who had undergone laparoscopic Nissen fundoplication for gastroesophageal reflux disease presented 14 months later with nausea and vomiting. Esophagogastroendoscopy showed obstruction of the esophagogastric junction and gastric mucosal necrosis. Emergency laparotomy showed the stomach to be entirely strangulated into the thorax, with areas of necrosis. Gastrotomy was followed by resection of the necrotic anterior wall of the stomach, closure of the hiatus, and suturing of the stomach to the diaphragm. Appropriate closure of crura and anchoring suture between the stomach and diaphragm are helpful to prevent recurrent hernia after laparoscopic Nissen fundoplication.

From the Department of Surgery, Fukuyama Municipal Hospital, Hiroshima, Japan.

Received June 2, 1999; revision received December 28, 1999; accepted January 7, 2000.

Address correspondence and reprint requests to Dr. Hitoshi Idani, Department of Surgery, Fukuyama Municipal Hospital, 5-23-1 Zaoh cho, Fukuyama, Hiroshima, 721-8511, Japan.

Copyright © 2000 Wolters Kluwer Health, Inc. All rights reserved.