Laparoscopic repair of a postadrenalectomy left-sided diaphragmatic hernia complicated by chronic colon obstruction

Abstract

Iatrogenic diaphragmatic hernias are a rarely reported complication of abdominal surgery. We present a case of an iatrogenic diaphragmatic hernia diagnosed 2 years after an adrenalectomy. Corrective laparoscopic surgery was performed, and the postoperative course was uneventful. The patient remained asymptomatic 6 months after the repair. To our knowledge, this is the first such case to be reported.

Robotic repair of iatrogenic left diaphragmatic hernia. A case report

“…Iatrogenic diaphragmatic hernia is a rare complication occurring after abdominal or thoracic surgery. Few cases have been reported after laparoscopic gastric interventions [ 6 ], nephrectomy [ 7 ], esophagectomy [ 8 ], laparoscopic left colectomy [ 9 ], laparoscopic cholecystectomy [ 10 ], laparoscopic hepatectomy [ 11 ], splenopancreatectomy [ 12 ] and adrenalectomy [ 1 ]. It occurs most commonly on the left side, because of the cushioning effect of the liver protecting the right hemidiaphragm [ 13 ].…”

“…In our best knowledge, this is the first robotic repair of a diaphragmatic defect after laparoscopic adrenalectomy. Another case has been described in literature in which the repair was performed with a laparoscopic approach [ 1 ].…”

“…Iatrogenic diaphragmatic hernia after laparoscopic left adrenalectomy has been rarely reported in adults [ 1 ]. Surgery is the preferred treatment because of the risks of incarceration, strangulation and pulmonary complications.…”

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

“…During the surgery, the patient is intubated with positive pressures in the chest, so it is easier for the orifice to remain collapsed. But in the post-operative period, the pressure gradient between the chest and the abdomen makes the area of weakness open and the small orifice dilates over time, until it allows migration of the abdominal organs into the chest [ 3 , 4 ]. Several factors can promote this mechanism: diaphragm with weak walls, increase in abdominal pressure or post-operative adhesions that can exert traction at the diaphragmatic level [ 2 ].…”

“…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 ].…”