Introduction: Traumatic rupture of the diaphragm with herniation of abdominal viscera into the pericardium is a rare injury. We present a case of intrapericardial diaphragmatic hernia after one year of thoracoabdominal trauma. This case is the 106th in the literature and only the fifth treated by the laparoscopic approach including this case. After case presentation, we will discuss post-traumatic intrapericardial diaphragmatic hernias by reviewing the literature.

Case Presentation: A 48-year-old male presented to our outpatient clinic with a history of thoracoabdominal trauma due to a motor vehicle accident one year ago. The patient complained from abdominal pain and constipation over the last year. After a thorough history and physical examination, thoracoabdominal computed tomography (CT) was performed. The CT scan revealed herniation of the transverse colon and omentum through a large anterior diaphragmatic defect into the pericardial sac. Laparoscopic composite mesh repair was done. The patient had an uneventful postoperative course and was discharged home on the second postoperative day. The patient was asymptomatic at regular follow-up six months postoperatively.

Conclusion: Late presentation of intrapericardial diaphragmatic hernia is rare. Chest computed tomography is the most useful diagnostic tool. Delayed diagnosis of Intrapericardial diaphragmatic hernia does not preclude laparoscopic repair by primary closure or with mesh according to the size of the defect.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229399PMC
http://dx.doi.org/10.1016/j.ijscr.2020.04.077DOI Listing

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Article Synopsis
  • Diaphragmatic hernias, traditionally linked to birth defects or trauma, can also occur due to surgical procedures, as shown in a rare case involving a 59-year-old woman after pericardial window surgery.
  • The patient experienced shortness of breath post-surgery, and imaging revealed an intrapericardial diaphragmatic hernia, leading to an open surgery for repair.
  • This case underscores the importance of recognizing and addressing rare complications like these postoperatively, highlighting the need for careful planning and intervention to prevent serious cardiac issues.
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