Bowel obstruction after cardiac surgery due to diaphragmatic unrecognised hernia

Abstract

Diaphragmatic hernia is a very rare occurrence after cardiac surgery without complications. We report a case of a 66-year-old male who underwent double aortocoronary bypass surgery, mitral and tricuspidal annuloplasty developed bowel obstruction 5 months after the operation. X-ray demonstrated small bowel loops in the left side of the chest. A laparoscopy was performed, but during the reduction of the hernia, patient suffered bradycardia because of adhesions between bowel and pericardical sac. Operation was interrupted and patient was transferred to our hospital where a cardiac surgery unit is present. No hemodynamic or respiratory deterioration was observed. Thoracic abdominal entero-CT, transthoracical echocardiography were performed. Patient underwent second surgery in cooperation with the cardial surgical team. Sternotomy was carried out. Hernial content was drawn onto the abdomen, diaphragmatic defect was closed with a direct suture. Mini-laparotomy was performed to exclude that the herniated small bowel did not have ischaemic suffering. No morbidity was observed in the post-operative course. This case illustrates the importance of an accurate pre-operative diagnosis in order to obtain information on relationship between loops of bowel and mediastinal organs. If sternotomy is required, surgical team must be supported by a cardiac surgical team.

Hiatal hernia after robotic-assisted coronary artery bypass graft surgery

“…The authors attributed these complications to a distended gastric cavity after surgery. Giuricin et al (18) described a bowel obstruction a few months after CABG due to a HH; the hernia was presumed to be unrecognized prior to surgery. Similarly, iatrogenic HH has been reported as a complication of surgical intervention at the hiatus esophagus (3) due to alteration of the EGJ and the neighboring structures.…”

Approach to a large rare diaphragmatic hernia in a patient undergoing cardiac surgery

“…Giuricin described a delayed case of incarcerated diaphragmatic hernia 5 months after cardiac surgery, which was not identified at the time of the primary procedure [9]. This required reoperation to reduce and repair the hernia.…”

An anterior diaphragmatic hernia incidentally found during coronary artery bypass graft surgery: a rare case report and review of the literature

“…In some cases, a patient’s signs and symptoms can be suggestive of a cardiac tamponade. The diagnostic algorithm mostly involves an X-ray or computed tomography (CT) imaging [ 1 , 6 , 7 ]. Those hernias might be easily misdiagnosed or overlooked, especially when a patient presents with other apparent conditions requiring emergency management.…”

“…Laparotomy, laparoscopy and thoracoscopy are possible approaches for repair operations. Transsternal access is indicated for patients who undergo concomitant cardiac surgery or when pericardial adhesions are present [ 7 , 8 ]. It was used in our case.…”

“…Five months later, presence of the intestine inside the thoracic cavity was revealed. The decision was made to perform the second surgery [ 7 ].…”