Diaphragmatic hernia after left intrapericardial pneumonectomy

The patient is a 62-year-old male with a history of left intrapericardial pneumonectomy 4 months earlier due to squamous cell carcinoma. He came to the emergency room due to uncontrollable vomiting, pain and abdominal distension. On examination, we observed: fair general condition, BP 90/40, HR 120 bpm, RR 24 breaths/min, O2 saturation 95%, pain in the epigastrium and left hypochondrium. CT scan showed: gastric chamber distention, diaphragmatic herniation of the gastric body into the left hemithorax, gastric pneumatosis, and portal pneumatosis (Fig. 1). We performed median supraumbilical laparotomy and hernia reduction, observing evidence of wall erythema secondary to a constriction ring and a 5-cm hole in the tendinous pair (Fig. 2). We conducted herniorrhaphy with interrupted stitches and invagination with continuous suture. The patient presented no postoperative complications.

Fig. 1

Fig. 2