Case report: Transdiaphragmatic gastric herniation: A rare complication of CABG using the right gastroepiploic artery

Intrapericardial Diaphragmatic Hernia after Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery Graft: Report of a Case

“…In the presence of risk factors such as persistent cough and obesity, an excessive orifice through which passes the GEA graft most likely causes a diaphragmatic hernia. 5,[8][9][10] An antegastric and antehepatic route for the GEA graft has been considered to prevent postoperative diaphragmatic hernia effectively, since the left lobe of the liver covers a diaphragmatic orifice for the GEA pedicle. In the present case, intrapericardial herniation of the stomach occurred in spite of the antegastric route, and the left lobe of the liver was also dislocated in the pericardial space.…”

“…To our knowledge, the duration from the onset of the hernia in the present case is the longest among all previous reports ( Table 1). [5][6][7][8][9][10][11][12][13] It is assumed that severe and prolonged obesity probably induced continuous high intra-abdominal pressure, resulting in hernia formation. This report does not intend to suggest abandoning the valuable arterial conduit.…”