We report a case of esophageal hiatal hernia with incarcerated stomach and perforated transverse colon in the right pleural cavity. An 84-year-old woman admitted for sudden dyspnea was found in chest X-ray to have atelectasis of the right lower lung lobe caused by gastrointestinal gas pressure. An upper gastrointestinal series showed the stomach incarcerated in the right pleural cavity and the retention of contrast medium in the stomach caused by organoaxial gastric volvulus. Chest CT showed the stomach and intestine incarcerated in the right pleural cavity and atelectasis of the right lower lung lobe, yielding a diagnosis of esophageal hiatal hernia with incarceration of the entire stomach and intestine in the right pleural cavity.
The hernia port was closed suturing the hiatus. The perforated colon is excised, and transverse colostomy was made transverse colostomy. Despite temporary recovery, the woman died of DIC and MOF 45 days after surgery.