Passing Through a Hole: Delayed Diaphragmatic Hernia After Cytoreductive Surgery

Abstract

A diaphragmatic hernia is a protrusion of abdominal contents into the thoracic cavity. Although it is commonly congenital, diaphragmatic hernias can also be acquired. Blunt or penetrating trauma are among the most frequent causes, although spontaneous or iatrogenic cases have been reported. Recently, some case reports related to diaphragmatic hernia after debulking surgery for advanced ovarian cancer have been described. This is an exceedingly rare but life-threatening complication, being prompt recognition and surgical correction critical.We report a case of a delayed diaphragmatic hernia in a 19-year-old female resulting from cytoreductive surgery for advanced ovarian cancer. Rapid evolution from gastrointestinal symptoms to hypovolemic shock occurred, and intensive care admission was required. Immediate surgery was critical to improving the patient outcome. This case highlights this uncommon but life-threatening complication, the challenges of diagnosing and managing those patients, and the need for early recognition, support, and surgical correction.

Gastric Volvulus: A Delayed Surgical Complication After Debulking and Hyperthermic Intraperitoneal Chemotherapy for Advanced Ovarian Cancer

“…Gastrointestinal symptoms can predominate when diaphragmatic eventration is associated with gastric volvulus with intermittent or complete outlet obstruction. 5 In our case, the patient presented with symptoms of gastric obstruction and in an acute setting. The diagnosis of gastric volvulus is usually based on barium studies.…”

“…5,9,10 Two of the cases were diagnosed intraoperatively as was our case; however, the rest of the cases were identified preoperatively using the computed tomography scan. 5–8 Time from cytoreductive surgery to diaphragmatic hernia presentation was 2 weeks to 1 and a half year, and our patient had a late presentation after 3 years. All were treated surgically like our case.…”

“…Three of the cases presented with signs of intestinal obstruction as was our case; otherwise, the others were incidental findings. 5,9,10 Two of the cases were diagnosed intraoperatively as was our case; however, the rest of the cases were identified preoperatively using the computed tomography scan. 5–8 Time from cytoreductive surgery to diaphragmatic hernia presentation was 2 weeks to 1 and a half year, and our patient had a late presentation after 3 years.…”

“…To date, only 8 cases of diaphragmatic hernia postcytoreductive surgery were found after a review in the literature performed using the PubMed engine 5,8–10 (Table 1). The male-to-female ratio was 1:3, and age at presentation ranged from 19 to 65 years.…”

“…Five cases report diaphragmatic hernia postcytoreductive surgery for ovarian cancer, 5,9,10 2 cases postsurgery for pseudomyxoma peritonei, 5,8 and 1 case postcytoreductive surgery for gastric cancer. 8 Four of these cases underwent HIPEC, 5 and 4 patients presented with gastric volvulus as our case. Three of the cases presented with signs of intestinal obstruction as was our case; otherwise, the others were incidental findings.…”