Pleural incarceration of the gastric graft after trans-hiatal esophagectomy

We report on a 73-year-old man who underwent a transhiatal esophagectomy fo r a T2N1M0 adenocarcinoma of the distal esophagus and developed an incarcer ated herniation of the gastric graft through a defect in the right mediasti nal pleura. The patient experienced delayed gastric emptying postoperativel y, which was initially suggested by barium swallow. The gastric herniation was unidentified by early postoperative swallowing studies and endoscopies. After diagnosis by a later computed tomographic scan and barium study, the herniation was reduced by incising the mediastinal pleura from the diaphra gm to the apex of the chest and by plication of the stomach longitudinally in order to reduce its intrathoracic diameter. (C) 1999 by The Society of T horacic Surgeons.