Intrathoracic liver herniation after pericardial fenestration – a case report

Abstract

Background Pericardial effusions with its potential life threatening progression towards cardiac tamponade have to be often managed with surgical intervention. In our case study we describe a complication after a common surgical procedure which has only scarce literature mentions. Case presentation We present a case of a 22-year-old male patient who underwent subxiphoidal pericardial fenestration, due to symptomatic pericardial effusion with the Chamberlain procedure and biopsy of enlarged mediastinal lymph nodes. The histology report confirmed classical Hodgkin lymphoma and subsequently the patient underwent oncological treatment. Later on he was admitted to the hospital with dyspnoea and chest pain. The initial examinations stated a suspicion for intrathoracic tumour arising from the pericardium or liver. Further investigation revealed symptomatic intrathoracic liver herniation for which the patient underwent laparoscopic surgery with the mobilisation of liver and placement of a perforated Parietene™ composite mesh. Conclusion The purpose of this case report is to describe a rare complication after pericardial fenestration with its potential clinical implications.

Pericardioperitoneal window creation for recurrent pericardial tamponade: A case report and literature review

“…The use of macroporous mesh has been recommended both to ensure that the pericardioperitoneal window remains open and to prevent the recurrence of the hernia after hernia reduction operation (7,22,23). Dubovan et al (24) successfully treated a patient with laparoscopic surgery in whom the liver herniated into the pericardial cavity through the pericardioperitoneal window. They repaired the defect with perforated Parietene™ composite mesh, consisting of a macroporous polypropylene mesh on one side and an absorbable synthetic lm on the other (24).…”

“…Dubovan et al (24) successfully treated a patient with laparoscopic surgery in whom the liver herniated into the pericardial cavity through the pericardioperitoneal window. They repaired the defect with perforated Parietene™ composite mesh, consisting of a macroporous polypropylene mesh on one side and an absorbable synthetic lm on the other (24). Once a pericardiodiaphragmatic hernia is diagnosed, emergent surgical therapy is indicated to reduce the hernia and repair the defect (19).…”