Diaphragmatic hernia following coronary artery bypass surgery with the right gastroepiploic artery: case report and literature review

Abstract

We report an unusual case of intrapericardial diaphragmatic hernia 2 years after coronary artery bypass surgery with the right gastroepiploic artery. Herniation through the orifice created for the right gastroepiploic artery caused small bowel strangulation and secondary volvulus requiring extensive small bowel resection due to acute mesenteric ischemia. This case highlights the importance of careful operative management of coronary artery bypass surgery with the right gastroepiploic artery and increases awareness of this rare but potentially fatal complication.

Diaphragmatic hernia post coronary artery bypass with gastroepiploic artery

“…However, some cases of herniations have been reported, which occurred through orifices for GEA grafts of 2 cm long slit or 1.5 cm hole. 2,3 In our case, the diaphragmatic defect size was 70 × 80 mm; we presumed that the defect had enlarged over 20 years after the initial surgery.…”

“…1 However, there are some reports of diaphragmatic herniation following the ante-hepatic route. 3,4 Shimamura et al 3 demonstrated the lack of clear evidence of the superiority of the ante-hepatic route over the retro-hepatic one.…”

“…However, several cases of diaphragmatic herniation through an orifice created for GEA graft have been reported. [1][2][3][4][5] This herniation may cause further complications such as mesenteric ischemia due to strangulation 1 or right-sided heart failure due to compression of the right ventricle. 5 Here, we report a case of right-sided heart failure due to the intraperitoneal diaphragmatic herniation of the transverse colon after CABG using the GEA.…”

Small bowel strangulation due to peritoneopericardial diaphragmatic hernia

“…Peritoneopericardial hernia may be congenital, arising from the failure of development of the transverse septum [ 1 ], or may follow rupture of the diaphragm after trauma [ 2 , 3 ]. A surgical cause has also been reported [ 4 , 5 ]. Since our patient had a defect of the central tendon of the diaphragm with peritoneopericardial communication and no history of trauma, we concluded that the defect was congenital.…”

“…It is very rare in humans. The cause of peritoneopericardial diaphragmatic hernia varies, as some authors have reported [ 1 - 5 ]. We herein report a case of peritoneopericardial diaphragmatic hernia with small bowel strangulation in a 75-year-old Korean man.…”