Diaphragmatic hernia a rare cause of acute pancreatitis: Case report

Abstract

Many complications are known to occur in association with a diaphragmatic hernia. Acute pancreatitis occurring in this situation is very rare. In this paper, we report a case and describe the radiographic features of this complication. We report an unusual case of acute pancreatitis complicating a neglected post-traumatic diaphragmatic hernia in a 30-year-old male. This patient had a history of an abdominal trauma 5 years ago, and arrived at the emergency room with epigastria and left chest pain and vomiting. Serum lipase was elevated. Acute pancreatitis could be considered as an exceptional complication of diaphragmatic hernia. It is a serious diagnostic and therapeutic challenge. The fundamental roles of CT are to determine the diaphragmatic defect, the abdominal content involving, the Balthazar scoring of pancreatitis, and the presence of local complications. Even if a conservative approach is preferred when facing a diagnosis of pancreatitis, timing of surgery should be carefully considered.

Missed at Birth: A Rare Case of Acute Pancreatitis Secondary to Congenital Diaphragmatic Hernia

“…Acute pancreatitis secondary to a diaphragmatic hernia is an extremely rare phenomenon. Adult-onset pancreatitis secondary to a congenital diaphragmatic hernia is almost unheard of, with only 2 prior cases reported in the literature, one patient 27 years of age and the other 35 years of age [ 9 , 10 ]. To our knowledge, this is the first reported case in the literature of pancreatitis secondary to a congenital diaphragmatic hernia in an adult greater than 60 years of age.…”

The uncommon diagnosis of hiatal hernia associated pancreatitis: A case report

“…Hiatal hernias are a part of diaphragmatic hernias [5] and are characterized by the trans-hiatal shifting of the abdominal contents into the chest [2] . The stomach is the most common organ to herniate, other less common herniations include transverse colon, small intestine, and spleen [6] .…”

“…Because the head segment of the pancreas and duodenum are positioned in the retroperitoneum and held by Treitz's ligament, pancreatic herniation is extremely rare [2] , [5] . But stretching of the transverse mesocolon due to increase in intra-abdominal pressure causes loosening of the posterior fascia resulting in pancreatic mobilization and herniation [7] .…”

“…As a result, pancreatic hiatal hernia associated with acute pancreatitis is extremely unusual, having been recorded in only 7 cases previously [3] . Though the mechanism of hernia-associated pancreatitis is no not completely elucidated yet, the authors attempted to discuss some possible causes: the parenchymal trauma resulting from repetitive transhiatal protrusion of the pancreas, intermittent stretching and traction of blood vessels such as the vascular pedicle, leading to ischemia lesions, volvulus or intermittent twisting of the pancreatic duct leading to pancreatic secretion against a permenant obstruction [3] , [5] , [7] . Incarceration of the pancreas resulting in anoxic injuries may also be another mechanism [10] .…”

“…Symptoms of acute pancreatitis caused by the herniation of pancreas in HH consist primarily of chest and epigastric pain [1] , [3] . Other manifestations include vomiting, dyspepsia, dyspnea, and diaphoresis [1] , [5] . The diagnosis is confirmed by elevation of pancreatic enzymes and imaging evidence of pancreatic herniation with inflammatory changes suggestive of pancreatitis (peripancreatic fluid, mesenteric stranding).…”