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KMID : 0378019900330060047
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New Medical Journal
1990 Volume.33 No. 6 p.47 ~ p.52
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A Cse og Type ⅢCongenial Esophageal Hiatal Hernia Combined with Hypoplasia of Right Lower Lobe of Lung
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한미숙/Han, Mi Suk
안영철/최성희/선경/Ann, Young Chul/Choe, Seong Hee/Sun, Kyung
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Abstract
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Type III congenital hiatal hernia of esophagus, i.e. combined sliding and rolling type, in right side is a very rare anomaly in korea.
We have experienced a case of this anomaly in male aged 3 years and 8 months old child whose only subjective symptom was recent postprandial vomiting with dehydration. On preoperative simple chest x-ray view, large air-filled cavitary lesion was noted in right lower medial lung field which closely contacted to right cardiac border. On chest CT scan and UGI study, esophagogastric junction was located above the diaphragm, and stomach body including antral portion and duodenal bulb were located in right chest cavity. Fiberscopy showed superficial mucosal erosion of distal esophagus suggestive reflux esophagitis, and that EG junction was located at 21 cm distal to incisor teeth.
Operation was done with combined approach using median laparotomy and right terolateral thoracotomy through the 7th intercostal space. Operative findings showed herniated but without strangulated viscus, mainly stomach from EG junction to duodenal first portion, covered by intact hernial sac in right thoracic cavity, 2 x 3cm hernial opening, through the right side of esophageal hiatus. So, reduction of herniated viscus, Belsey-Mark N f duplication, herniorrhaphy with posterior reinforcement of hiatus, and feeding gastrostomy were done. Intraoperative fiberscopy showed EG junction at 27cm distal to incisor teeth. Postoperative courses were uneventful, and gastrostomy tube was removed on 10th postoperativeve day after follow-up UGI study.
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KEYWORD
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