Intestinal Obstruction Caused by an Incarcerated Diaphragmatic Hernia After an Ivor-Lewis Procedure

The patient is a 68-year-old male with a history of esophageal adenocarcinoma (ypT3N1M0) treated with neoadjuvant chemotherapy and esophagectomy by a minimally invasive Ivor Lewis technique (abdominal phase) one year before.

He came to our Emergency Department due to abdominal pain, vomiting and constipation over the course of the previous 3 days. During examination, he presented dyspnea, abdominal pain upon palpation (especially in the right abdomen), guarding and signs of peritoneal irritation.

Chest radiography showed a supradiaphragmatic air bubble (Fig. 1). Therefore, a computed tomography scan was performed, which revealed ascension of the transverse colon through the esophageal hiatus with distension of the right colon and collapse of the left colon (Fig. 2).

Fig. 1

Fig. 2