Nonoperative management of complicated hiatal hernia after transhiatal esophagectomy- case report

Introduction: Hiatal hernia is rare after transhiatal esophagectomy occurring in less than 2% of patients [5]. Due to the rare incidence of hiatal hernias after transhiatal esophagectomy overlooking this differential in a symptomatic patient can be problematic. Patients can presents with recurrent pneumonia, complaints of reflux, and in the case presented small bowel obstructions. Surgery has been the mainstay of treatment for symptomatic hiatal hernias. This case report poses that nonoperative management is a viable treatment option for patients with complicated hiatal hernias after transhiatal esophagectomy. Presentation of case: We present the case of a mechanical small bowel obstruction occurring at the esophageal hiatus in a patient four years after transhiatal esophagectomy. The patient was successfully managed nonoperatively with resolution of small bowel obstruction and persistent hiatal hernia. Conclusion: Hiatal hernias after transhiatal esophagectomy are a rare entity. Complications of these hernias with mechanical small bowel obstructions are even less described in the current literature. It is important to recognize hiatal hernias as a potential cause of obstructive symptoms after esophagectomy. While surgical intervention may be inevitable in certain population of patients. Initial nonoperative management is a viable treatment option and should be utilized in high risk operative patients.