Left diaphragmatic hernia following thoracoabdominal aortic repair: A case report. (2020)

• Record Type: Journal Article
• Authors: Castillo Barbosa, Andrea; Pérez Rivera, Carlos J.; Tellez, Luis Jaime; Cabrera Rivera, Paulo; González-Orozco, Alejandro; Mosquera Paz, Manuel
• Is Part Of: International journal of surgery case reports. Volume 70(2020)
• Page Start: 209
• Page End: 212
• Publication Date: 2020
• Subjects: MRI magnetic resonance imaging -- CT-scan computed tomography scan; Diaphragmatic hernia -- Laparoscopic approach -- Thoracoabdominal aortic repair -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.04.038
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Diaphragmatic hernias are unusual thoracoabdominal complications, often misdiagnosed given its late clinical manifestations. Diaphragmatic hernias requiring emergency intervention are high-risk due to visceral strangulation. Clinical suspicion must be considered in a gastrointestinal symptoms with prior thoracoabdominal aortic repair. Immediate surgical intervention may be considered as the gold standard in delayed diaphragmatic rupture. Abstract: Introduction: Diaphragmatic hernias are somewhat rare complications of thoracoabdominal interventions. Given their late clinical manifestations and misdiagnosis, their incidence is unknown. These hernias have a high mortality risk when an emergency intervention is warranted due to complications from visceral strangulation. Case presentation: We present the case of a 67-year-old male with prior history of thoracoabdominal aortic repair, who reconsults due to upper gastrointestinal bleeding. Upon arrival, imaging shows a left diaphragmatic herniation with migration of the stomach, omentum and spleen to the thoracic cavity. Through laparoscopic approach, a left diaphragmatic hernial defect is identified with protrusion of half the stomach, omentum and the posterior aspect of the spleen with a sub capsular tear. Additionally, a severe adhesion syndrome on the chest wall and diaphragm were also evident, with entrapment of the inferior lobe of the left lung. The contents were successfully reduced, however pulmonary decortication and extensive adhesiolysis through thoracoscopy was required for complete extraction, enabling a primary repair without tension. Conclusions: We present an infrequent pathology without an established incidence, which has relevant clinical and surgical implications at any level of care, in this case requiring interdisciplinary management. The suspicion of diaphragmatic hernia in a patient with past medical history of thoracoabdominal aortic repair with non-specific gastrointestinal symptoms is essential. We emphasize the importance of clinical suspicion of this complication once the surgical precedent has been identified.