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J Thorac Cardiovasc Surg 2009;138:495-496
© 2009 The American Association for Thoracic Surgery

Brief Clinical Report

An unusual case of a strangulated lung hernia after an Ivor Lewis esophagectomy

Rony Atoui, MD, MSc, Lawrence Lee, Lorenzo Ferri, MD, PhD*

Division of Thoracic Surgery, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada

Received for publication April 6, 2008; accepted for publication April 13, 2008.

* Address for reprints: Lorenzo Ferri, MD, PhD, Division of Thoracic Surgery, McGill University Health Center, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada. (Email: lorenzo.ferri@muhc.mcgill.ca).

The first 20% of the full text of this article appears below.


   Introduction
 
Intercostal lung herniation is a rare condition that most commonly occurs after a traumatic event or through a congenital defect. We report an unusual case of a right lung hernia after an Ivor Lewis esophagectomy that was found to be strangulated and necrotic, requiring a wedge resection.


   Clinical Summary
 
A 30-year-old morbidly obese man with distal esophageal adenocarcinoma underwent an uneventful Ivor Lewis esophagectomy and thereafter had 3 cycles of docetaxel (Taxotere), cisplatin, and 5-flourouracil chemotherapy. An en-bloc resection with 2-field lymphadenectomy was performed through a laparotomy and right thoracotomy, and a hand-sewn esophagogastric anastomosis was generated cephalad to the azygous vein. The ribs were reapproximated with 4 interrupted figure eight, no. 1, nonlooped polydioxanone sutures. Postoperatively, the patient actively and enthusiastically participated in chest physiotherapy, including early ambulation and forced coughing. On postoperative day 8, he had intermittent low-grade fever; however, a barium swallow and a chest computed tomographic (CT) scan did not reveal an anastomotic leak or mediastinal abscess. On . . . [Full Text of this Article]




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