Left diaphragmatic hernia complicated by perforation of an intrathoracic gastric ulcer into the aorta: report of a case

Our plain-English summary of Left diaphragmatic hernia complicated by perforation of an intrathoracic gastric ulcer into the aorta: report of a case, by Y. Saito, Y. Yamakawa, H. Niwa, et al (Surgery Today, 2000).

The study

• Authors: Y. Saito, Y. Yamakawa, H. Niwa, M. Kiriyama, I. Fukai, S. Kondo, Y. Fujii
• Journal: Surgery Today
• Published: 2000;30(1):63-5
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We describe herein a rare but fatal complication of diaphragmatic hernia that occurred in a 51-year-old man 3 years after his diaphragm had been repaired by a polytetrafluoroethylene sheet following resection during pleuropneumonectomy for a left pleural mesothelioma. He was admitted to our hospital in shock status, and was found to have massive bleeding from the nasogastric tube. An emergency operation revealed that an ulcer of the stomach, which had been displaced into the left thorax, had perforated directly into the descending aorta.

In plain English

This was a case report from Japan describing one patient, a 51-year-old man who had undergone pleuropneumonectomy for a left pleural mesothelioma three years earlier. During that operation part of his diaphragm was removed, and the gap was repaired with a polytetrafluoroethylene (Gore-Tex) sheet. The repair failed about two months later, letting the stomach move into the left chest. The patient did not consent to an operation to repair this hernia. He was admitted in shock with heavy bleeding from his nasogastric tubes and a hemoglobin of 6.3 g/dl. At emergency surgery, most of the Gore-Tex sheet had split along the suture line. An ulcer in the displaced stomach had perforated directly into the descending aorta. Attempts to control the bleeding failed, and the patient died during the operation. The authors concluded that surgeons should be aware of the risk of gastroaortic fistula (an opening between the stomach and the aorta) with a diaphragmatic hernia, and that the case showed the importance of early repair. The article does not discuss asbestos exposure.

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 51-year-old man admitted to a hospital in Japan (Nagoya City University Medical School authors), who had had a pleuropneumonectomy for left pleural mesothelioma 3 years earlier
• Exposure: The article does not report asbestos or any occupational exposure. The relevant history is prior surgery for left pleural mesothelioma, with the resected diaphragm repaired using a polytetrafluoroethylene (Gore-Tex) sheet.
• Main results:
  • The diaphragm repair failed 2 months after the mesothelioma operation, and the stomach moved into the chest.
  • The patient did not consent to an operation to repair the hernia.
  • On admission the patient's hemoglobin was low at 6.3 g/dl.
  • At emergency surgery, most of the Gore-Tex sheet from the first operation had split along the suture line.
  • An ulcer in the herniated stomach had perforated directly into the descending aorta, which it had adhered to.
  • The patient died during the operation from massive bleeding from the aorta.
• The authors' conclusion: The authors concluded that surgeons should be aware of the risk of gastroaortic fistula with a diaphragmatic hernia. They stated that the case demonstrates the risk of leaving a diaphragmatic hernia unrepaired and the importance of early repair.

Topics

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

Related studies

• Biological materials for diaphragmatic repair: initial experiences with the PeriGuard Repair Patch® — P. Zardo, R. Zhang, et al. (2011)
• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)
• What caused gastrointestinal bleeding in a woman with a history of pleural mesothelioma? Metastatic diffuse epithelioid mesothelioma — F. Iafrate, S. Sibio, et al. (2010)
• False aneurysm of ascending aorta due to pericardial mesothelioma — V. Uspenskiy, A. Lavreshin, et al. (2012)
• Malignant pleural mesothelioma presenting as an acute surgical abdomen due to metastatic jejunal perforation — K. Gocho, K. Isobe, et al. (2010)
• Jejunal Perforation by Metastasis of Malignant Pleural Mesothelioma — M.I. Navarro García, A. Sánchez Pérez, et al. (2015)

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