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Iatrogenic diaphragmatic hernia after pulmonary artery banding operation through median sternotomy. Indian J Thorac Cardiovasc Surg 2019; 35:94-96. [PMID: 33060982 DOI: 10.1007/s12055-018-0723-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022] Open
Abstract
Diaphragmatic hernias following cardiac surgeries in general are being reported after coronary artery bypass grafting using the right gastro-epiploic artery as a conduit as well as in patients with ventricular assist devices, orthotopic heart transplants, or subxiphoid epicardial pacemakers. We report a case of an iatrogenic diaphragmatic hernia following pulmonary artery banding operation through median sternotomy which was discovered 4 years later during the debanding and ventricular septal defect closure operation. The diaphragm was most likely injured during insertion of the retro-sternal tube during the first operation.
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Adeel MY, Sikanderkhel S, Shahab Z, Oliva I, Gerber J. Asymptomatic adult intrapericardial diaphragmatic hernia detected on cardiac SPECT CT. J Nucl Cardiol 2018; 25:1875-1878. [PMID: 29147830 DOI: 10.1007/s12350-017-1129-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 11/29/2022]
Abstract
An 83-year-old man underwent exercise stress test with single photon emission computed tomography (SPECT) myocardial perfusion imaging for new electrocardiogram (EKG) changes. The stress EKG did not show any significant changes. Myocardial perfusion imaging with SPECT demonstrated an inferior wall defect and extracardiac uptake of nuclear tracer. Simultaneous cardiac computed tomography performed for attenuation correction showed presence of intrapericardial hepatic tissue in an anterior diaphragmatic hernia. The herniated tissue was noted to influence the perfusion image and cause the defect. To date, this is a unique finding based on review of literature.
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Affiliation(s)
| | - Saad Sikanderkhel
- Yale University School of Medicine and Yale New Haven Hospital, New Haven, CT, USA
| | - Zartashia Shahab
- Yale University School of Medicine and Yale New Haven Hospital, New Haven, CT, USA
| | - Isabel Oliva
- Yale University School of Medicine and Yale New Haven Hospital, New Haven, CT, USA
| | - Jaime Gerber
- Yale University School of Medicine and Yale New Haven Hospital, New Haven, CT, USA
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Saito T, Yasui K, Kurahashi S, Komaya K, Ishiguro S, Arikawa T, Komatsu S, Kaneko K, Miyachi M, Sano T. Intrapericardial diaphragmatic hernia into the pericardium after esophagectomy: a case report. Surg Case Rep 2018; 4:94. [PMID: 30105742 PMCID: PMC6089855 DOI: 10.1186/s40792-018-0499-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background Intrapericardial diaphragmatic hernia (IPDH), defined as prolapse of the abdominal viscera into the pericardium, is a rare clinical condition. This case illustrates the possibility of IPDH after esophagectomy with antethoracic alimentary reconstruction, although such hernias are extremely rare. IPDH often presents with symptoms of bowel obstruction such as abdominal discomfort or vomiting. If not properly treated, life-threatening necrosis and/or perforation of the herniated contents may occur. Case presentation A 68-year-old Japanese man underwent subtotal esophagectomy with three-field lymph node dissection for treatment of esophageal cancer. Completion gastrectomy with perigastric lymph node dissection was also performed because the patient had previously undergone distal partial gastrectomy for treatment of gastric cancer. The alimentary continuity was reconstructed using the pedicled jejunal limb through the antethoracic route. When we separated the diaphragm from the esophagus and removed xiphoid surgically to prevent a pedicled jejunal limb injury, the pericardium was opened. The patient was readmitted to our hospital because of abdominal discomfort and vomiting 6 months after the esophagectomy. A diagnosis of IPDH after esophagectomy was made. The patient was treated by primary closure of the diaphragmatic defect using vertical mattress sutures and additional reinforcement of the closing defect using a graft harvested from the rectus abdominis posterior sheath. The postoperative course was uneventful, and he was discharged on the seventh day after hernia repair. Conclusions This patient’s clinical course provides two important clinical suggestions. First, we must be aware of the possibility of iatrogenic IPHD after esophagectomy with antethoracic alimentary reconstruction. Second, a graft from the rectus abdominis posterior sheath is beneficial in the treatment of IPDH.
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Affiliation(s)
- Takuya Saito
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Kohei Yasui
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shintaro Kurahashi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenichi Komaya
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Seiji Ishiguro
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Arikawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Masahiko Miyachi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Farcy DA, Lapietra A, Abo BN, Dalley M. Pericardial Herniation of Small Bowel Post Minimally Invasive Hybrid Maze of Atrial Fibrillation. J Emerg Med 2017; 53:e33-e36. [PMID: 28756933 DOI: 10.1016/j.jemermed.2017.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Herniation of intraabdominal contents into the pericardial cavity is exceptionally rare, and when seen, it is most often the result of trauma, postsurgical complication, or genetic defect. There have been only a few case reports describing spontaneous bowel herniation into the pericardium in minimally invasive cardiac procedures like cardiac ablation, pacemaker placement, and minimally invasive coronary artery bypass graft. CASE REPORT We report the case of a 65-year-old man who presented to an urgent care center complaining of abdominal and chest pain. This patient had recently undergone a laparoscopic hybrid maze procedure and ultimately had an incarcerated loop of small bowel herniate into the pericardial sac. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We present this case to increase awareness among emergency physicians of the diagnosis of a pericardial hernia in patients presenting with gastrointestinal or cardiorespiratory symptoms after surgical procedures involving the diaphragm.
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Affiliation(s)
- David A Farcy
- Department of Emergency Medicine, Mount Sinai Medical Center of Miami, Miami Beach, Florida
| | - Angelo Lapietra
- Division of Cardiothoracic Surgery, Mount Sinai Medical Center of Miami, Miami Beach, Florida
| | - Benjamin N Abo
- Department of Emergency Medicine, Mount Sinai Medical Center of Miami, Miami Beach, Florida
| | - Michael Dalley
- Department of Emergency Medicine, Mount Sinai Medical Center of Miami, Miami Beach, Florida
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Lee JH, Kim SW. Small bowel strangulation due to peritoneopericardial diaphragmatic hernia. J Cardiothorac Surg 2014; 9:65. [PMID: 24694166 PMCID: PMC4230424 DOI: 10.1186/1749-8090-9-65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/20/2014] [Indexed: 11/10/2022] Open
Abstract
A 75-year-old Korean man was referred to our hospital with cramping abdominal pain. His chest X-ray showed an abnormal air shadow above the diaphragm, and computed tomography showed an abdominal viscera in the pericardium. We performed surgery and confirmed peritoneopericardial diaphragmatic hernia with small bowel strangulation. Postoperative course was uneventful. Peritoneopericardial diaphragmatic hernia is very rare in humans, so we report the case with a literature review.
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Affiliation(s)
- Jang-Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, Daemyeong 5-dong, Nam-gu, Daegu 705-717, Korea.
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Benson CC, Valente AM, Economy KE, Hoffman-Sage Y, Bevilacqua LM, Podovei M, Opotowsky AR. Discovery and management of diaphragmatic hernia related to abandoned epicardial pacemaker wires in a pregnant woman with {S,L,L} transposition of the great arteries. CONGENIT HEART DIS 2011; 7:183-8. [PMID: 21718459 DOI: 10.1111/j.1747-0803.2011.00547.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Epicardial pacemaker leads placed during childhood are often not removed when transvenous systems are placed later in life. The risk of complications related to retained pacemaker leads and generators is not clear but is generally considered low. We report the case of a 23-year-old pregnant woman who presented with left upper quadrant pain at 20 weeks gestation. The patient was born with {S,L,L} transposition of the great arteries and had high-grade conduction disease in infancy compelling epicardial pacemaker placement. A standard transvenous pacemaker was placed at age 9 years, without removal of the epicardial system. The patient's abdominal pain was attributed to herniation of abdominal contents through a diaphragmatic defect at the site of the abandoned epicardial pacing wire. Her pain improved spontaneously but worsened later in pregnancy leading to repair of the diaphragmatic hernia via anterolateral thoracotomy at 30 weeks gestation. The procedure was well tolerated by mother and fetus. At 38 3/7 weeks gestation, the patient underwent uneventful delivery by cesarean section for breech presentation. This case illustrates the importance of multidisciplinary collaboration in the care of women with congenital heart disease.
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Affiliation(s)
- Craig C Benson
- Combined Internal Medicine-Pediatrics Residency, University of Rochester Medical Center, Rochester, New York, USA
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Panda BR, Sumangala SG, Katewa A, Naik SK, Mishra J, Kumar RK. Intrapericardial diaphragmatic hernia after arterial switch operation. Ann Thorac Surg 2010; 90:e73-4. [PMID: 20971225 DOI: 10.1016/j.athoracsur.2010.07.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 07/11/2010] [Accepted: 07/21/2010] [Indexed: 11/28/2022]
Abstract
Intrapericardial diaphragmatic hernia after median sternotomy for cardiothoracic procedures is a rare complication. We describe an interesting case of diaphragmatic hernia in a 6-month-old girl presenting as cardiac tamponade, 4 months after an arterial switch operation. The diaphragmatic defect was iatrogenic and emphasizes the danger of inadvertent diaphragmatic injury during cardiac operations.
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Affiliation(s)
- Biswa Ranjan Panda
- Department of Pediatric and Congenital Heart Surgery, Kochi, Kerala, India.
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Drafts BC, Chughtai HL, Entrikin DW. Iatrogenic intrapericardial diaphragmatic hernia diagnosed by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:3. [PMID: 20064206 PMCID: PMC2817870 DOI: 10.1186/1532-429x-12-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 01/08/2010] [Indexed: 11/30/2022] Open
Abstract
Intrapericardial diaphragmatic hernias are very uncommon and are most typically caused by high-force blunt trauma. Other iatrogenic causes such as prior surgical formation of a pericardial window have been described, but are exceedingly rare. We present a case of an intrapericardial diaphragmatic hernia in a patient with a prior pericardial window in which the diagnosis was unclear using conventional imaging modalities, but was established using cardiovascular magnetic resonance.
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Affiliation(s)
- Brandon C Drafts
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Haroon L Chughtai
- Department of Cardiology, Saint Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA
| | - Daniel W Entrikin
- Departments of Radiology and Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Affiliation(s)
- Ronald Y Chin
- Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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Landau O, Schachner A, Lerner MA, Hauptman E, Friedman M, Levy MJ. Pneumothorax due to delayed rupture of traumatic trans-diaphragmatic gastric hernia. Eur J Radiol 1990; 10:59-61. [PMID: 2311608 DOI: 10.1016/0720-048x(90)90089-t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- O Landau
- Department of Cardiothoracic Surgery, Beilinson Medical Center, Petah Tikva, Israel
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Abstract
Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25.6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.
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