Migración de la malla a la unión gastroesofágica: una complicación infrecuente de la reparación de una hernia hiatal gigante / Mesh migration into the gastroesophageal junction: a rare complication of giant hiatal hernia repair

Resumen El reparo de la hernia hiatal es un tema de debate debido a las posibles complicaciones asociadas que han cambiado a través de los años. En la literatura se reportan complicaciones asociadas al procedimiento hasta en un 30 % de los casos. Las complicaciones diferentes a la recurrencia y a largo plazo son infrecuentes, reportadas en menos del 9 % de los casos. La inclusión de la malla protésica en el esófago es una rara complicación y solo se han reportado pocos casos sobre esta. Entre los factores asociados a este desenlace se encuentran descritos: el material protésico, la técnica quirúrgica y la tensión de la malla sobre el tejido intervenido; sin embargo, es difícil establecer asociaciones directas de cada factor dado que la literatura actual solo cuenta con reportes de casos. A continuación, se muestra el caso clínico de un paciente, quien, después de una reparación de hernia hiatal con malla, presenta la inclusión de material protésico en el esófago; se aborda el diagnóstico y el manejo de la misma.

Abstract Hiatal hernia repair has been a subject of debate due to the possible associated complications that have changed over the years. The literature reports up to 30% of cases with complications associated with the procedure. Complications other than recurrence and long-term complications are rare and reported in less than 9% of cases. The migration of the prosthetic mesh into the esophagus is a rare complication and only a few cases have been reported. The factors associated with this outcome include prosthetic material, surgical technique, and mesh tension on the intervened tissue. However, it is difficult to establish direct associations of each factor since the current literature has only case reports. The following is a clinical case of a patient in whom the prosthetic material migrated into the esophagus after a hiatal hernia repair with mesh. The diagnosis and treatment offered are discussed.

Migration of Pyloric Self-Expanding Metallic Stent to the Esophagus / 대한소화기내시경학회지

Self-expandable metallic stent (SEMS) has been reported to provide effective treatment alternatives with minimal morbidity for patients with malignant gastroduodenal obstruction. Limitations of SEMSs are stent occlusion due to tumor ingrowth or overgrowth and stent migration. Migrated stents may remain in the stomach or travel distally. To our knowledge, however, migration of pyloric SEMS to the esophagus has not been reported. We experienced such a case in a 65-year-old woman who had undergone a gastrojejunostomy and choledochojejunostomy due to unresectable pancreatic head cancer. Pyloric SEMSs (Niti-S Pyloric Bare Stent, 18x60 mm, Taewoong Medical, Korea) were deployed at the obstructed efferent and afferent loops. After severe vomiting, a pyloric SEMS placed at the afferent loop migrated into the esophagus, which caused severe chest pain and intractable hiccup. It was removed endoscopically. This case illustrates that pyloric SEMS can migrate to the esophagus through the lower esophageal sphincter.