Successful Management of a Perforated Interposed Substernal Ileocolon Caused by Right Pleural Hernia Atsushi Shiozaki, MD, Hitoshi Fujiwara, MD, Hirotaka.

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Successful Management of a Perforated Interposed Substernal Ileocolon Caused by Right Pleural Hernia Atsushi Shiozaki, MD, Hitoshi Fujiwara, MD, Hirotaka Konishi, MD, Tomohiro Arita, MD, Toshiyuki Kosuga, MD, Ryo Morimura, MD, Yasutoshi Murayama, MD, Shuhei Komatsu, MD, Yoshiaki Kuriu, MD, Hisashi Ikoma, MD, Masayoshi Nakanishi, MD, Daisuke Ichikawa, MD, Kazuma Okamoto, MD, Eigo Otsuji, MD The Annals of Thoracic Surgery Volume 101, Issue 1, Pages e5-e7 (January 2016) DOI: 10.1016/j.athoracsur.2015.08.081 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Postoperative roentgenogram of the chest (after esophagectomy) revealed visible right pleural hernia of esophageal substitute and visible shadowing of lower right lung (arrow). (B) Thoracoabdominal computed tomography (in emergency situation) showed bilateral pleural effusion and air with right pleural hernia of esophageal substitute. The Annals of Thoracic Surgery 2016 101, e5-e7DOI: (10.1016/j.athoracsur.2015.08.081) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Operative findings. (A) Right thoracotomy revealed 3-cm perforation in cecum (arrow). (B) Perforation was sutured directly. (C) We made redundant ileum straight in thoracic cavity. (D) Repaired cecum was pulled down into abdominal cavity. Arrow shows suture line of cecum. The Annals of Thoracic Surgery 2016 101, e5-e7DOI: (10.1016/j.athoracsur.2015.08.081) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Right thoracotomy revealed 3-cm perforation in cecum and right pleural hernia of redundant ileocolon. (B) After suturing perforation directly, we made redundant ileum straight and pulled down repaired cecum into abdominal cavity. The Annals of Thoracic Surgery 2016 101, e5-e7DOI: (10.1016/j.athoracsur.2015.08.081) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions