Small bowel volvulus presenting with diaphragmatic hernia after minimal invasive esophagectomy
Journal
Journal of the Formosan Medical Association
Journal Volume
115
Journal Issue
2
Pages
128-129
Date Issued
2016
Author(s)
Abstract
A 54-year-old man presented with severe epigastralgia after dinner. He was sent to the Emergency Department. He had a past history of hypertension and had undergone an operation for esophageal adenocarcinoma 9 months prior to this presentation. Esophagectomy was performed using a minimally invasive method, along with laparoscopic gastric tube mobilization and esophagogastric anastomosis. His postoperative progress was excellent. However, he experienced severe epigastric discomfort after eating dinner, which was accompanied by severe nausea and vomiting. On examination, his vital signs were within normal limits and hedid not have respiratory distress: blood pressure, 144/ 90 mmHg; temperature, 36.1 C; pulse rate, 82 beats/min; respiratory rate, 20 breaths/min; and oxygen (O2) saturation, 99%. His pain was persistent and could be relieved by bending forward. The vomitus comprised food content without bile, blood, or coffee ground substances. Physical examination showed hyperactive bowel sounds and epigastric tenderness. There was no muscle guarding or rebound pain. Laboratory data showed elevated lactic acid level (4.32 mmol/L). Chest plain film showed prominent bowel loops in the left chest cavity without subphrenic free air (Fig. 1A). Noncontrast computed tomography (CT) showed hiatal hernia and small bowel volvulus (Fig. 1B and 1C).
SDGs
Type
journal article