The Tip of The Iceberg: An Unusual Case of Diaphragmatic Hernia Presenting as A Breast Abscess

Abstract

In this case report we illustrate an atypical presentation of diaphragmatic hernia as a colocutaneous fistula. An 83-year-old female with history inclusive of hiatal hernia repair and multiple ventral hernia repairs presented with purulence from her left breast. CT scan was performed showing a colon-containing diaphragmatic hernia protruding between left-sided ribs, with an overlying left breast collection. She was taken to the OR, and after extensive lysis of adhesions, a large left diaphragmatic hernia was encountered with perforated colonic diverticulitis in the hernia sac extending to the colocutaneous fistula via the breast. The hernia sac was dissected down, the colon was mobilized, and a left segmental colectomy was performed to include the area of involved pathology, with primary anastomosis, and the diaphragmatic defect was repaired primarily. It is important to consider unusual presentations of diaphragmatic hernia, including any pathology involving any intraabdominal organs incarcerated within the defect.