Oskay KAYA, Melih AKINCI, Hakan KULAÇOĞLU, Gürkan GÜNERİ, İdil Güneş TATAR, Kerim Bora YILMAZ

İnkarsere paraözefagial hiatal herni içinde mide perforasyonuna bağlı peritonit: Olgu sunumu

Altmışbeş yaşındaki erkek hasta karın ağrısı ve kanlı kusma şikâyetleri ile acile başvurdu. Hastanın radyolojik tet- kiklerinde toraks içinde hiatal herni yerleşimli torsiyone mide, omental doku ve yaygın hava-sıvı seviyeleri izlen- mekte idi. Cerrahi eksplorasyon sırasında hastanın mide ön yüzdeki 4 cmlik perforasyonuna bağlı gıda artıkları vekan mevcut idi. Diyafram ve mide primer onarımı, beslenme tüpleri ve Bogota bag uygulanan hasta peritonite bağlısepsis ve multi organ yetmezliği nedeni ile postoperatif dokuzuncu saatte kaybedildi. Hiatal herniler elektif şartlardalaparoskopi ve açık cerrahi teknikle tedavi edilebilmektedir. Bu yazıda tedavisiz kalan bir paraözefagial hiatal hernihastasında toraks içinde mide perforasyonu ve peritonit tablosu sonucu mortalite ile seyreden bir olgu sunulmuştur.

Peritonitis associated with gastric perforation in an incarcerated paraesophageal hernia

A 65-year old male admitted to emergency department due to bloody vomiting and abdominal pain. Radiologicalexaminations showed extensive intraperitoneal free air, prolapsed stomach and free fuid at the abdomen. Duringlaparotomy a perforation measuring 4 cm length, revealing blood and fuid containing a lot of aliment in the ab- dominal cavity was recognized. Hiatal hernia was repaired by partial closure of the hernia orifce, feeding tube wasinserted. The abdominal cavity was left open and covered with a Bogota bag for temporary closure. The patientdied nine hours after surgery due to diffuse peritonitis and multiple organ failure. Paraosephagial hiatal hernias canbe performed laparoscopic or open techniques repair where possible. We report an untreated case of incarceratedparaesophageal hernia with perforation of the stomach fundus and peritonitis.

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