Pleural Incarceration of the Transverse Colon after Transthoracic Esophagectomy - A case report -

개흉적 식도절제술 후 횡행결장의 흉강 내 탈장 - 1예 보고 -

  • Jang, Hee-Jin (Department of Thoracic and Cardiovascular Surgery, Seoul Natinal University Hospital, Seoul National University College of Medicine) ;
  • Lee, Hyun-Sung (Center for Lung Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Zo, Jae Ill (Center for Lung Cancer, Research Institute and Hospital, National Cancer Center)
  • 장희진 (서울대학교 의과대학 서울대학교병원 흉부외과학교실) ;
  • 이현성 (국립암센터 폐암센터) ;
  • 조재일 (국립암센터 폐암센터)
  • Received : 2008.07.14
  • Accepted : 2008.08.07
  • Published : 2009.02.05

Abstract

A 65 year-old man, who underwent transthoracic esophagectomy for mid-thoracic esophageal squamous cell carcinoma, suffered from an incarcerated herniation of the transverse colon through a defect in the left mediastinal pleura. The patient had a gas collection in the left lower lung field and this then insidiously progressed; the final result was total collapse of the left lung and hemodynamic compromise. The life-threatening herniation of the transverse colon into the pleural cavity after pervious esophagectomy was corrected by emergency laparotomy. Postoperative pulmonary complications after esophagectomy can induce potentially lethal transhiatal herniation because of the danger of intestinal obstruction or strangulation. The optimal approach to transhiatal herniation after esophagectomy is prevention.

중부 식도암에서 개흉적 식도절제술을 시행 받은 65세 남자가 식도열공 직상부의 좌측 종격 흉막이 찢어진 곳을 통해 횡행결장의 흉강내 탈장이 발생하였다. 단순흉부촬영상 좌측 하폐야에 공기음영의 누적이 발견되었고 이는 점차 진행하여 좌측 폐를 완전히 허탈시키고 혈역학적 불안정을 야기하였다. 식도절제술 후 생명을 위협하는 흉강내로의 탈장은 응급 개복술을 통하여 교정되었다. 식도절제술 후 식도열공을 통한 흉강내 탈장은 장의 폐색이나 꼬임의 위험 때문에 생명을 위협할 가능성이 있어 증상이 있는 환자에서 응급으로 복부절개를 통한 탈장의 수술적 복원을 시행하여야 한다. 하지만 식도절제술시 이러한 합병증의 예방을 위한 신중이 최우선일 것이다.

Keywords

References

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