Tags

Type your tag names separated by a space and hit enter

Post-operative gastric outlet obstruction of giant hiatal hernia repair: a case report.
BMC Gastroenterol. 2022 Feb 05; 22(1):47.BG

Abstract

BACKGROUND

Giant hiatal hernia is defined as those with more than 30% of the stomach herniating into the chest cavity. The transabdominal laparoscopic approach is the well-established repair form for giant hiatal hernia. To our best knowledge, reports on post-operative gastric outlet obstruction of giant hiatal hernia repair have been scanty up till now.

CASE PRESENTATION

A 45-year-old female patient was referred to the Emergency Department of our hospital with a chief complaint of acute right epigastric pain for 2 days. Physical examination revealed mild tenderness in the right epigastrium, without rebound tenderness or guarding. The abdominal computed tomography scan revealed a large low-density gastric artifact in the lower mediastinum-giant hiatal hernia. The barium swallow esophagogram and gastroscopy also confirmed the presence of a giant hiatal hernia. A transabdominal laparoscopic operation for reduction of the hernia contents and repair of the hiatal defect was performed. Her right epigastric pain alleviated obviously on the first postoperative day. On post-operative day five, however, she was presented with nausea and vomiting independent of meals. The nasogastric tube was inserted and kept in the stomach for 7 days. After removing the nasogastric tube, severe nausea and vomiting of the patient occurred again. Barium swallow revealed gastroptosis and enfoldment in the duodenal bulb, which indicated the presence of gastric outlet obstruction. Gastrojejunostomy was performed for her to relieve the gastric outlet obstruction. The patient was discharged on the tenth day after the second operation without any discomfort. During the regular follow-up period, she felt well and was satisfied with her status.

CONCLUSIONS

Facing the giant hiatal hernia repair, the reduction of the hernia contents and repair of the hiatal defect being well operated on are insufficient, and we must watch out the anatomical variation, like the deviation of partial intra-abdominal organs from their normal positions, as well as paying attention to the protection of abdominal vagal nerve during the operation. Post-operative gastric outlet obstruction of giant hiatal hernia repair is rare, while gastrojejunostomy can successfully relieve the gastric outlet obstruction.

Authors+Show Affiliations

Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, 650032, Yunnan Province, China.Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, 650032, Yunnan Province, China.Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, 650032, Yunnan Province, China.Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Wuhua, Kunming, 650032, Yunnan Province, China. bsunq@qq.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

35123402

Citation

Li, ZhaoPeng, et al. "Post-operative Gastric Outlet Obstruction of Giant Hiatal Hernia Repair: a Case Report." BMC Gastroenterology, vol. 22, no. 1, 2022, p. 47.
Li Z, Xie F, Zhu L, et al. Post-operative gastric outlet obstruction of giant hiatal hernia repair: a case report. BMC Gastroenterol. 2022;22(1):47.
Li, Z., Xie, F., Zhu, L., & Sun, L. (2022). Post-operative gastric outlet obstruction of giant hiatal hernia repair: a case report. BMC Gastroenterology, 22(1), 47. https://doi.org/10.1186/s12876-022-02117-z
Li Z, et al. Post-operative Gastric Outlet Obstruction of Giant Hiatal Hernia Repair: a Case Report. BMC Gastroenterol. 2022 Feb 5;22(1):47. PubMed PMID: 35123402.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-operative gastric outlet obstruction of giant hiatal hernia repair: a case report. AU - Li,ZhaoPeng, AU - Xie,FuJia, AU - Zhu,Lin, AU - Sun,Liang, Y1 - 2022/02/05/ PY - 2021/06/15/received PY - 2022/01/24/accepted PY - 2022/2/6/entrez PY - 2022/2/7/pubmed PY - 2022/2/9/medline KW - Case report KW - Complications KW - Giant hiatal hernia KW - Laparoscopy KW - Surgery SP - 47 EP - 47 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 22 IS - 1 N2 - BACKGROUND: Giant hiatal hernia is defined as those with more than 30% of the stomach herniating into the chest cavity. The transabdominal laparoscopic approach is the well-established repair form for giant hiatal hernia. To our best knowledge, reports on post-operative gastric outlet obstruction of giant hiatal hernia repair have been scanty up till now. CASE PRESENTATION: A 45-year-old female patient was referred to the Emergency Department of our hospital with a chief complaint of acute right epigastric pain for 2 days. Physical examination revealed mild tenderness in the right epigastrium, without rebound tenderness or guarding. The abdominal computed tomography scan revealed a large low-density gastric artifact in the lower mediastinum-giant hiatal hernia. The barium swallow esophagogram and gastroscopy also confirmed the presence of a giant hiatal hernia. A transabdominal laparoscopic operation for reduction of the hernia contents and repair of the hiatal defect was performed. Her right epigastric pain alleviated obviously on the first postoperative day. On post-operative day five, however, she was presented with nausea and vomiting independent of meals. The nasogastric tube was inserted and kept in the stomach for 7 days. After removing the nasogastric tube, severe nausea and vomiting of the patient occurred again. Barium swallow revealed gastroptosis and enfoldment in the duodenal bulb, which indicated the presence of gastric outlet obstruction. Gastrojejunostomy was performed for her to relieve the gastric outlet obstruction. The patient was discharged on the tenth day after the second operation without any discomfort. During the regular follow-up period, she felt well and was satisfied with her status. CONCLUSIONS: Facing the giant hiatal hernia repair, the reduction of the hernia contents and repair of the hiatal defect being well operated on are insufficient, and we must watch out the anatomical variation, like the deviation of partial intra-abdominal organs from their normal positions, as well as paying attention to the protection of abdominal vagal nerve during the operation. Post-operative gastric outlet obstruction of giant hiatal hernia repair is rare, while gastrojejunostomy can successfully relieve the gastric outlet obstruction. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/35123402/Post_operative_gastric_outlet_obstruction_of_giant_hiatal_hernia_repair:_a_case_report_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-022-02117-z DB - PRIME DP - Unbound Medicine ER -