Faecopneumothorax Caused by Perforated Diaphragmatic Hernia
Incarcerated diaphragmatic hernias with intrathoracic perforation of the colon is a very rare but serious surgical emergency. A 78-year-old male patient presented to our emergency department with severe abdominal pain. A computer tomography (CT) scan revealed herniation of the left transverse colon...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Surgery |
| Online Access: | http://dx.doi.org/10.1155/2020/8860336 |
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| author | Kristina Necke Nickolaus Heeren Francesco Mongelli Maurice FitzGerald Jürgen Fornaro Fabrizio Minervini Jürg Metzger Jörn-Markus Gass |
| author_facet | Kristina Necke Nickolaus Heeren Francesco Mongelli Maurice FitzGerald Jürgen Fornaro Fabrizio Minervini Jürg Metzger Jörn-Markus Gass |
| author_sort | Kristina Necke |
| collection | DOAJ |
| description | Incarcerated diaphragmatic hernias with intrathoracic perforation of the colon is a very rare but serious surgical emergency. A 78-year-old male patient presented to our emergency department with severe abdominal pain. A computer tomography (CT) scan revealed herniation of the left transverse colon and spleen into the thorax with colon perforation and fecal contents in the thoracic cavity. An emergent laparotomy confirmed the radiological diagnosis and showed a 6 cm dehiscence of the left diaphragm with strangulation of the left transverse colon as well as the spleen. A left-sided hemicolectomy with terminal transversostomy and splenectomy were performed. The diaphragm was closed with interrupted nonabsorbable sutures. We abstained from reinforcement of the suture line with a mesh because of the feculent contamination of the abdominal cavity. After extensive thoracoscopic lavage and insertion of two chest tubes, the patient was transferred to the intensive care unit. Diaphragmatic hernia even after a mild chest trauma can cause fatal complications. Diagnosis and treatment can be challenging and an interdisciplinary approach is recommended. Due to the associated comorbidity and long-lasting sequelae, we believe the awareness of this rare pathology as a differential diagnosis is important; both as an abdominal and thoracic emergency. |
| format | Article |
| id | doaj-art-66ecfa61b66d4944808ca61fa968d9a4 |
| institution | Kabale University |
| issn | 2090-6900 2090-6919 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Surgery |
| spelling | doaj-art-66ecfa61b66d4944808ca61fa968d9a42025-02-03T00:58:48ZengWileyCase Reports in Surgery2090-69002090-69192020-01-01202010.1155/2020/88603368860336Faecopneumothorax Caused by Perforated Diaphragmatic HerniaKristina Necke0Nickolaus Heeren1Francesco Mongelli2Maurice FitzGerald3Jürgen Fornaro4Fabrizio Minervini5Jürg Metzger6Jörn-Markus Gass7Department of Surgery, Cantonal Hospital of Lucerne, Lucerne, SwitzerlandDepartment of Surgery, Cantonal Hospital of Lucerne, Lucerne, SwitzerlandDepartment of Surgery, Cantonal Hospital of Lucerne, Lucerne, SwitzerlandDepartment of Surgery, Regional Hospital of Bellinzona, Bellinzona, SwitzerlandDepartment of Radiology, Cantonal Hospital of Lucerne, Lucerne, SwitzerlandDepartment of Thoracic Surgery, Cantonal Hospital of Lucerne, Lucerne, SwitzerlandDepartment of Surgery, Cantonal Hospital of Lucerne, Lucerne, SwitzerlandDepartment of Surgery, Cantonal Hospital of Lucerne, Lucerne, SwitzerlandIncarcerated diaphragmatic hernias with intrathoracic perforation of the colon is a very rare but serious surgical emergency. A 78-year-old male patient presented to our emergency department with severe abdominal pain. A computer tomography (CT) scan revealed herniation of the left transverse colon and spleen into the thorax with colon perforation and fecal contents in the thoracic cavity. An emergent laparotomy confirmed the radiological diagnosis and showed a 6 cm dehiscence of the left diaphragm with strangulation of the left transverse colon as well as the spleen. A left-sided hemicolectomy with terminal transversostomy and splenectomy were performed. The diaphragm was closed with interrupted nonabsorbable sutures. We abstained from reinforcement of the suture line with a mesh because of the feculent contamination of the abdominal cavity. After extensive thoracoscopic lavage and insertion of two chest tubes, the patient was transferred to the intensive care unit. Diaphragmatic hernia even after a mild chest trauma can cause fatal complications. Diagnosis and treatment can be challenging and an interdisciplinary approach is recommended. Due to the associated comorbidity and long-lasting sequelae, we believe the awareness of this rare pathology as a differential diagnosis is important; both as an abdominal and thoracic emergency.http://dx.doi.org/10.1155/2020/8860336 |
| spellingShingle | Kristina Necke Nickolaus Heeren Francesco Mongelli Maurice FitzGerald Jürgen Fornaro Fabrizio Minervini Jürg Metzger Jörn-Markus Gass Faecopneumothorax Caused by Perforated Diaphragmatic Hernia Case Reports in Surgery |
| title | Faecopneumothorax Caused by Perforated Diaphragmatic Hernia |
| title_full | Faecopneumothorax Caused by Perforated Diaphragmatic Hernia |
| title_fullStr | Faecopneumothorax Caused by Perforated Diaphragmatic Hernia |
| title_full_unstemmed | Faecopneumothorax Caused by Perforated Diaphragmatic Hernia |
| title_short | Faecopneumothorax Caused by Perforated Diaphragmatic Hernia |
| title_sort | faecopneumothorax caused by perforated diaphragmatic hernia |
| url | http://dx.doi.org/10.1155/2020/8860336 |
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