Recurrent hiatal hernia causing small bowel obstruction secondary to herniation into right hemithorax following prior esophagectomy: a case report

Hiatal hernias occur when abdominal contents, typically the stomach, herniate through the esophageal hiatus into the mediastinum, causing symptoms such as reflux, chest pain, and dysphagia. Surgical repair aims to restore anatomy and prevent complications such as obstruction or strangulation. While sliding hernias are more common, paraesophageal hernias more frequently necessitate surgery. A case of small bowel herniation into the right hemithorax through a recurrent hiatal hernia in a 77-year-old male with a history of reflux and stage II esophageal adenocarcinoma treated with neoadjuvant chemoradiation, immunotherapy, and esophagectomy. He presented with abdominal pain and dyspnea. Computed tomography imaging revealed small bowel obstruction due to herniation into the thoracic cavity. Emergent intervention included laparoscopic hiatal hernia repair and open small bowel resection. The patient's postoperative course was uneventful, and follow-up imaging at 3 months showed no recurrence. This case underscores the importance of timely surgical intervention in managing complex recurrent paraesophageal hernias.