Incarcerated Thoracic Gastric Herniation after Nephrectomy: A Report of Two Cases

Abstract

Iatrogenic diaphragmatic hernias can occur after abdominal or thoracic surgery. Acute presentation of a diaphragmatic hernia varies depending on the extent and nature of the organ which has herniated. The initial diagnosis can be challenging due to the nonspecific nature of the presenting symptoms. Delay in diagnosis poses a significant risk to the patient, and a rapid deterioration can occur in the context of strangulation. We outline two cases of acute gastric herniation through a defect in the diaphragm after an open and a laparoscopic nephrectomy. Both had characteristic findings on imaging, required emergency, surgery and had a successful outcome. Both cases highlight the potential for late presentation with non-specific symptoms and the necessity for urgent surgical management where gastric perfusion is compromised.

Mesocolic hernia following retroperitoneal laparoscopic radical nephrectomy: A case report

“…We sometimes experience adhesional hernias after abdominal surgery, however, an internal hernia after RLN is rare. We searched PubMed for reports of an internal hernia after RLN, and only 17 cases have been reported in literature including our case (Table 1) [1,2,5,[10], [11], [12], [13], [14], [15], [16], [17], [18], [19]]. Radical nephrectomy for cancer and donor nephrectomy comprised of seven cases each.…”

Post-nephrectomy diaphragmatic hernia. Increase suspicion and decrease morbi-mortality: two cases report

“…The majority are located on the left side, probably due to the ‘protective’ effect that the liver exerts over the diaphragm (hence the special rarity of our first case), and can develop from the first day to years after the procedure [ 5 ]. In post-nephrectomy hernias, patients may present with latent symptoms or it may appear as a casual finding in an imaging test, which means that this pathology can be underdiagnosed [ 6 ].…”

“…In cases of acute symptoms, the most typical symptom is epigastric and/or chest pain, which is at times associated with dyspnea, reduced breath sounds and even appearance of bowel sounds in the chest. Obstructive symptoms could appear when the hernia contains a hollow organ [ 4 , 5 , 7 ]. Delayed diagnosis can lead to a life-threatening outcome with ischemia or perforation of the herniated organs [ 5 ].…”

“…Obstructive symptoms could appear when the hernia contains a hollow organ [ 4 , 5 , 7 ]. Delayed diagnosis can lead to a life-threatening outcome with ischemia or perforation of the herniated organs [ 5 ]. To confirm the diagnosis, chest X-rays can show irregularity in the diaphragmatic contour, organ herniation in the chest, pleural effusion and/or mediastinal shift to the other side.…”

Rare complication of diaphragmatic hernia in a live donor nephrectomy patient

“…Small perforations commonly remain collapsed and unrecognized 10 . The pressure gradient between the intra‐thoracic and intra‐abdominal compartments, and the constant diaphragmatic motion following extubation causes the defect to progressively enlarge over time allowing intra‐thoracic herniation of abdominal organs 9 . Predisposing factors are fragile diaphragmatic musculature, including areas of congenital weakness in the posterior diaphragm between the costal and lumbar portions, and increased traction by post‐operative adhesions 10 .…”