vaka sunumu case report - Koşuyolu Heart Journal

KORONER BYPASS CERRAHİSİ İLE BERABER HİATUS HERNİS TAMİRİ:
VAKA SUNUMU
CASE REPORT: HIATAL HERNIA REPAIR DURING CORONARY ARTERY
BYPASS SURGERY
Hasan Reyhanoğlu1, Kaan Özcan1, Hidayet Çatal2, Suna Güzeldoğan2, Ümit İlker Tekin3
1 Özel Tınaztepe Hastanesi, Kalp Damar Cerrahisi Kliniği, İzmir, Türkiye
2 Özel Tınaztepe Hastanesi, Genel Cerrahi Kliniği, İzmir, Türkiye
3 Özel Tınaztepe Hastanesi, Kardioloji Kliniği, İzmir, Türkiye
Hiatal hernia is defined as the displacement of a portion of the stomach through the
diaphragmatic esophageal hiatus to the thorax.
1,2,3
. Therefore, symptoms of disease can vary. A
61-year-old male patients was admitted with chest pain and occasional progressive shortness of
breath. After performing a chest CT scan and coronary angiography, it was decided that the
patient would undergo surgery (Figure-1).
After median sternotomy, the hiatal hernia was seen (Figure-2 and Figure-3). The
sternotomy incision was extended by the general surgeon, and defect repair was performed
with a 15x15 cm dual mesh. After hernia repair, coronary bypass surgery (CABGX3; LIMA-LAD,
Ao-D1, Ao–RCA bypass) was performed using cardiopulmonary bypass. The patient was
discharged on the fifth postoperative day without any problems.
In conclusion, to determine the correct diagnosis for patients admitted with chest pain, it
is important to consider hiatal hernia within extra-cardiac factors.
References
1- Cangır AK, Ökten İ. Hiatus hernileri ve tedavi yaklaşımı. Ankara Üniversitesi Tıp fakültesi
Mecmuası 1998;51(1):43-48
2- Teke Z, Atalay F, Demirbağ AE, Neşşar G, Elbin OH. Paraözofageal (Tip II hiatal) hernilerde
cerrahi yaklaşım:dört olgu sunumu. Ulusal Cerrahi Dergisi 2009;25(1):33-39
3- Papoulidis P, Beaty JW, Dandekar U. Hiatal hernia causing extrapericardial tamponade after
coronary bypass surgery. İnterac Cardiavasc Thorac surg; 2014;19(4):716-7
Figure 1: Preoperative thorax CT image
Figure 2: Perioperative mediastinum image
Figure 3: Intra-abdominal organs from perioperative mediastinum