Incarceration of a diaphragmatic hernia complicated by a tension fecopneumothorax after left hemihepatectomy: Review of the literature and case report

Abstract

Incarceration of abdominal organs in a diaphragmatic hernia is a potentially life-threatening condition. It is associated with significant morbidity and mortality. A successful management of this entity requires fast and correct diagnosis and prompt treatment.To our knowledge we report the first case of gastric incarceration in an iatrogenic diaphragmatic hernia with consequent intrathoracic perforation and tension pneumothorax.Etiological was an open left hemihepatectomy for a benign tumor in a 71-year old male. In a combined thoraco-abdominal approach we successfully sutured the diaphragmatic defect and resected the stomach fundus.In a comprehensive review of the literature we illustrate standards and pitfalls in diagnostics and treatment of diaphragmatic hernia in emergency setting. While most diaphragmatic hernias are congenital or posttraumatic, reports of iatrogenic diaphragmatic hernias are increasing. As an incarcerated diaphragmatic hernia is easy to miss, a high index of suspicion is necessary. Our case illustrates, that delayed presentation or diagnosis may lead to severe complications and that complicated diaphragmatic hernia present a big surgical challenge.