Trans-hiatal small-bowel herniation after laparoscopic radical total gastrectomy for gastric cancer: a case report and literature review

Trans-hiatal hernia is a rare but serious complication after total gastrectomy. We report a 71-year-old man who underwent laparoscopic radical total gastrectomy, D2 lymphadenectomy, and Roux-en-Y reconstruction for cardia adenocarcinoma. Computed tomography (CT) on postoperative day 17 showed intrathoracic displacement of the esophagojejunal anastomosis without obstruction. Ten months later, he developed positional upper abdominal pain, and CT revealed herniation of the anastomosis and a dilated jejunal loop through the esophageal hiatus into the right thoracic cavity. Emergency laparoscopic reduction and hiatal repair were performed. The bowel was viable, and crural, and pleural defects were repaired with sutures. Recovery was uneventful. Early postoperative intrathoracic migration of the anastomosis may be a warning sign of delayed trans-hiatal hernia, and symptomatic patients require prompt CT diagnosis and surgical repair.