An unusual diaphragmatic hernia with gastric perforation and sub-acute presentation

When laparoscopic repair is feasible for diaphragmatic hernia in adults? A retrospective study and literature review

BACKGROUND

Diaphragmatic hernia (DH), congenital or traumatic, is uncommon but sometimes can lead to a serious surgical emergency. There are no clinical guidelines or approved recommendations for the management of this condition, and most data are from retrospective, single-institution series. The aim is to analyze the management of the DH at our institution and review the indications for laparoscopic repair.

METHODS

A retrospective serie of patients diagnosed of DH with surgical treatment at our institution between 2009 and 2019. Literature review was carried out to establish the current indications of laparoscopic repair in each type of DH.

RESULTS

Surgery was carried out in 15 patients with DH, 5 congenital and 10 traumatic hernias. Traumatic hernias were classified as acute (n = 2) and chronic (n = 8). 53.4% of all cases (8 patients) required urgent surgery using an abdominal approach (5 open and 3 laparoscopic) and elective surgery was performed in 46.6% of all cases (7 patients) with an abdominal approach (3 open and 4 laparoscopic) and 2 patients with a combined approach. Primary repair was performed in 4 patients (26.6%), closure and mesh reinforcement in 9 cases (60%) and only mesh placement in 2 patients (13.4%). Postoperative morbidity and mortality were 20% and 0%, respectively. No recurrences were detected.

CONCLUSIONS

DH may pose different scenarios which require urgent or elective surgical treatment. Laparoscopic approach may be a first option in elective surgery; and in emergency setting taking into account hemodynamic stability and associated injuries.

The rare and unusual presentation of a gastric perforation in the setting of a large diaphragmatic hernia: a case report and literature review

Diaphragmatic hernias are either congenital or acquired defects in the diaphragm that permit passing of abdominal contents into the chest cavity. Individuals with large diaphragmatic hernias associated with a gastric perforation have rarely been reported in literature and can have serious mortality rates. Herein, we present a case of gastric perforation in the setting of a significant sized diaphragmatic hernia. The value of the current report compared to previously published cases is the sub-acute nature and lack of any indicative features on initial presentation which can lead to misdiagnosis and serious morbidity later in life.