A case of diaphragmatic hernia incarceration after a heart transplant operation

We report a case of a diaphragmatic hernia after a heart transplant operation. A 43-year-old woman, who underwent orthotropic heart transplantation for hypertrophic cadiomyopathy two year earlier, presented with vomiting and epigastric pain. A computed tomography scan showed that the stomach and transverse colon were dislocated in the left thoracic cavity. We diagnosed left diaphragmatic hernia incarceration and performed laparoscopic repair of the diaphragmatic hernia. A 12 × 8 cm diaphragmatic defect was found intraoperatively on the ventrolateral aspect of the left diaphragm, and the stomach with volvulus had herniated into the thorax through the defect. The hernia was considered to be iatrogenic. The diaphragmatic defect was large, and the diaphragm was thinning. We closed the defect by mesh repair. Laparoscopic mesh repair of the diaphragmatic hernia could be performed safely and with minimal invasiveness.     

Thoracoscopic repair for late-presenting congenital diaphragmatic hernia with thoracic kidney in a child

Congenital diaphragmatic hernia (CDH) with a hernia sac and thoracic kidney is a very rare congenital anomaly. Recently, the usefulness of endoscopic surgery for CDH has been reported. We herein report a patient who underwent thoracoscopic repair of CDH with a hernia sac and thoracic kidney. A 7-year-old boy was referred to our hospital due to a diagnosis of CDH without clinical symptoms. Computed tomography showed herniation of the intestine into the left thorax and left-sided thoracic kidney. The key points of operation are resection of the hernia sac and identification of the suturable diaphragm under the presence of the thoracic kidney. In the present case, after repositioning the kidney to the subdiaphragmatic area completely, the border of the diaphragmatic rim was clearly visualized. Good visibility allowed resection of the hernia sac without damaging the phrenic nerve and closure of the diaphragmatic defect.     

Single-incision laparoscopic full-thickness anterior abdominal wall repair of a Morgagni hernia using a suture-assisting needle in a child: A case report

Single-incision laparoscopic repair of a congenital Morgagni diaphragmatic hernia using a suture-assisting needle was performed in a 1-year-old boy. Three ports were inserted through a single umbilical incision to repair the 2.5 × 2.3-cm defect. The full-thickness muscle layer of the anterior abdominal wall and the posterior rim of the defect were penetrated with the suture-assisting needle holding a thread, which was then released. The needle tip was pulled back over the muscle layer, shifted laterally, and again passed through the muscle layer and the posterior rim. The thread was then captured by the needle and pulled out through the anterior abdominal wall. Five mattress sutures were placed in this way and tied subcutaneously. The postoperative course was uneventful, and the cosmetic outcome was favorable. A suture-assisting needle is useful for completing full-thickness anterior abdominal wall repair, which is important for preventing the recurrence of a congenital Morgagni diaphragmatic hernia.     

Laparoscopic repair of Bochdalek hernia with intrathoracic kidney in a 2‐year‐old child

Intrathoracic kidney with Bochdalek hernia is a very rare congenital anomaly. Some case reports have discussed repair by laparotomy or thoracotomy. We report a case in a child performed using a laparoscopic approach. A 2‐year‐old boy arrived at our hospital with gastric volvulus caused by a left‐sided Bochdalek hernia. CT also showed a left‐sided intrathoracic kidney. After conservative therapy for the volvulus, laparoscopic repair of the diaphragmatic hernia was performed. The key problem during the operation was the presence of the intrathoracic kidney. If direct closure of the hernia had been performed without the intrathoracic kidney having been relocated to the abdomen, a complete closure would have been impossible because of the renal vessels. After the intrathoracic kidney was relocated to the abdomen, the diaphragmatic defect was closed. The boy has been doing well without complications for 5 years, and CT reveals that the left‐sided kidney is almost normally positioned.     

Laparoscopic-assisted thoracoscopic repair of latent traumatic diaphragmatic hernia: A case report

Surgical approaches for traumatic diaphragmatic hernia include transabdominal, transthoracic, and thoracoabdominal. Selection of the optimal approach depends on the timing and organ damage, often minimally invasive approaches with laparoscopy or thoracoscopy are performed. A 47-year-old man with blunt chest trauma was diagnosed with left traumatic diaphragmatic hernia 1 month after the trauma. The prolapsed omentum was detached from the chest wall and around the hernia orifice and returned to the abdominal cavity by coordinated thoracoscopic and laparoscopic manipulations. The 4 × 2 cm herniation in the diaphragm was sutured closed from the thoracic side while preventing re-prolapse of the omentum and abdominal organs from the abdominal side. A combined thoracoscopic and laparoscopic approach can be effective in confirming organ damage, repositioning of prolapsed organs, and safe repair of the diaphragm in latent traumatic diaphragmatic hernia.     

Single-incision laparoscopic repair for a Morgagni hernia: A case report

A Morgagni hernia is a rare type of congenital diaphragmatic hernia. Here, a case of a Morgagni hernia repaired by SILS is presented. A 78-year-old woman was admitted to our hospital with nausea and vomiting. On CT, the transverse colon and antrum of the stomach were prolapsed into the right thoracic cavity. The herniated stomach was repositioned by emergency endoscopy, and SILS repair was performed electively. Laparoscopy showed the hernial orifice, which was 75 × 50 mm in diameter, on the right side and behind the sternum. Although the transverse colon had herniated through the defect into the right diaphragm, it was easily reduced into the abdominal cavity. Composite mesh was sutured to cover the hernial orifice. No perioperative complications or hernia recurrence have been observed in the 8 months since the surgery.     

Use of the transabdominal approach to repair Morgagni hernia in a 28‐year‐old symptomatic female: A case report

Morgagni''s hernia is a congenital diaphragmatic hernia, which represents only 3% of all diaphragmatic hernias. Herein, we report a case of a 28‐year‐old symptomatic female patient with Morgagni''s hernia who underwent a transabdominal surgery for hernia repair and mesh placement.     

Thoracoscopic repair of a large neonatal congenital diaphragmatic hernia using Gerota's fascia

A large congenital diaphragmatic hernia needing patch repair has a high risk of recurrence. Thus, managing these large congenital diaphragmatic hernias under thoracoscopy has become a problem. Here, a large congenital diaphragmatic hernia that was repaired using Gerota's fascia under thoracoscopy is reported. In the present case, it was impossible to close the hernia directly under thoracoscopy because the hernia was too large. Gerota's fascia was raised up by the left kidney and used for the repair. The left colon adhering to Gerota's fascia was mobilized, and a large space was made under thoracoscopy. Gerota's fascia was fixed to the diaphragmatic defect. The patient's postoperative course was good, and there was no recurrence. This technique could be one option for repairing a large hernia under thoracoscopy.     

Laparoscopic mesh repair of parahiatal hernia: A case report

We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh. A 51‐year‐old woman presented with vomiting and epigastric pain. CT scan showed a giant paraesophageal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic, making a tension‐free primary repair difficult. A laparoscopic mesh repair was performed with a composite mesh, which was covered with the hernia sac to prevent potential erosion into the esophagus or stomach. Recovery was uneventful and the patient was discharged on the 5 days postoperatively. She remained asymptomatic at subsequent follow‐up. Laparoscopic repair of parahiatal hernia can be safely performed. In circumstances where a large or fibrotic defect prevents a tension‐free primary repair, the use of a composite mesh can provide effective repair of the hernia.     

Gastric Volvulus Through Morgagni Hernia: An Easily Overlooked Emergency

Background

Intractable vomiting in an elderly patient is an emergency condition requiring prompt diagnosis and intervention. Acute gastric outlet obstruction due to gastric volvulus through Morgagni-type diaphragmatic hernia is an exceedingly rare cause of this nonspecific complaint.

Objective

Our aim was to highlight that Morgagni hernia, although rare in adults, should be suspected in the appropriate clinical setting, and that a clue toward diagnosis often comes from routine chest and abdominal x-ray studies. In addition, we emphasize the atypical radiological findings and importance of emergency surgical intervention in such a case.

Case Report

We describe the case of a 78-year-old woman who presented to the Emergency Department with a 4-day history of intractable vomiting, and with no definitive clue to the diagnosis on examination. Her routine chest and abdomen x-ray studies suggested abnormal air-fluid level at right hemithorax, which prompted a computed tomography (CT) scan of the abdomen and an upper gastrointestinal contrast study. Gastric volvulus through a foramen of Morgagni was diagnosed and transthoracic reduction of the contents was performed, along with repair of the defect.

Conclusions

A symptomatic Morgagni hernia in adults, although rare, can present with a variety of symptoms ranging from nonspecific complaints of bloating and indigestion to the more severe complaint of intestinal obstruction. Gastric volvulus and obstructive features are less frequently reported as acute complications of these hernias, which need early identification and intervention.     

Rare case of a right Bochdalek hernia with retroperitoneal prolapse of organs into the thoracic cavity in infancy: A case report

We report an extremely rare case of a right Bochdalek hernia with a sac, in which the retroperitoneal and intra-abdominal organs prolapsed into the thoracic cavity at the same time. The patient was a 7-month-old female with no comorbidities. She presented with cough and fever, and chest radiography revealed a right diaphragmatic hernia. Computed tomography showed that the right kidney, intestine, colon, and liver had prolapsed into the thoracic cavity. The patient underwent thoracoscopic surgery, which showed that the abdominal and retroperitoneal organs prolapsed into the thoracic cavity through the Bochdalek hernia. The herniated organs were spontaneously reduced using thoracoscopic insufflation. The defect hole was closed with artificial mesh. We adopted a thoracoscopic approach, in terms of easy reduction of herniated organs and accurate evaluation of the hernia orifice, which was useful.     

Magnetic resonance imaging of Morgagni hernia

A case of a Morgagni hernia is demonstrated by magnetic resonance imaging (MRI). The correct diagnosis was facilitated by the ability to image directly the anteromedial diaphragmatic defect in the coronal and sagittal planes. The findings from MRI, computed tomography, and radiographic studies are correlated.     

Laparoscopic repair of traumatic diaphragmatic hernia with colon incarceration: A case report

Traumatic diaphragmatic hernia is a serious complication of blunt trauma to the abdomen or thorax. Although traumatic diaphragmatic hernia is treated with surgical repair, a laparoscopic approach is infrequently employed. Here we present the case of a 66-year-old man with a bruise on the left side of his back. CT revealed a left pneumothorax and left rib fractures. He was urgently hospitalized and relieved with conservative treatment. However, on day 4 of hospitalization, an incarcerated diaphragmatic hernia containing the transverse colon was observed on CT. The herniated viscera of the abdominal cavity were reduced laparoscopically, and the hernial orifice was repaired with direct closure. One-lung ventilation was used to limit the movement of the affected diaphragm, enabling effective laparoscopic suturing. The patient had an uneventful recovery period and was discharged 8 days postoperatively. The absence of diaphragmatic herniation recurrence was confirmed 6 months after surgery.     

Adult Bochdalek hernia following living donor left hepatectomy repaired by thoracoscopy-assisted surgery: A case report

Bochdalek hernia is a congenital diaphragmatic hernia (DH). Herein, we report a case of adult Bochdalek hernia following living donor hepatectomy repaired by thoracoscopy-assisted surgery. A 36-year-old man underwent living donor left hepatectomy. Four months later, the patient presented with acute epigastric pain. Computed tomography found the left-sided DH in which the stomach was incarcerated into the pleural cavity without ischemic changes. As endoscopic intervention was unsuccessful, the herniated stomach was repositioned by thoracoscopy-assisted surgery. The 3-cm hernia orifice was found to have a smooth edge with no hernia sac, suggesting Bochdalek hernia, and the defect was primarily closed. The patient was followed up for 20 months without hernia recurrence. This is the first presentation of a case of Bochdalek hernia following donor hepatectomy. In cases of early detected DH, primary repair via a transthoracic approach with thoracoscopy-assisted surgery is safe and feasible.     

A case of Spigelian hernia after laparoscopic incisional hernia repair

Laparoscopic ventral hernia repair with intraperitoneal onlay mesh reinforcement is often performed in clinical practice. We herein describe a patient who developed a Spigelian hernia at the edge of the mesh due to rupture of the muscular layer in the abdominal wall. A 69-year-old woman developed a left-sided abdominal bulge 15 months after laparoscopic ventral hernia repair. CT showed a 33-mm defect in the abdominal wall at the lateral edge of the left abdominal rectus muscle with an intestinal prolapse through the defect. She was diagnosed with a Spigelian hernia and underwent operation. The hernia orifice was located at the aponeurosis of the transverse abdominal muscle where the thread had been used to fix the mesh through all layers of the abdominal wall. This report details a case of a Spigelian hernia after laparoscopic ventral hernia repair.     

Left diaphragmatic eventration diagnosed as congenital diaphragmatic hernia by prenatal sonography

Congenital diaphragmatic eventration is an abnormal elevation of the diaphragm resulting from failure of muscle fibers to develop during gestation. A mediastinal shift to the contralateral side may cause significant compression of the affected chest contents, resulting in compromised pulmonary function, especially when both sides are involved. Differentiating between congenital diaphragmatic eventration and congenital diaphragmatic hernia is very difficult but important because eventration has a better perinatal outcome than diaphragmatic hernia has. This report discusses a case of congenital diaphragmatic eventration that was initially diagnosed by prenatal sonography as a diaphragmatic hernia on the left side. In this case, the correct diagnosis was made at the time of surgery shortly after the infant's birth. The defect was repaired by plication, and the infant's outcome was favorable. Although the initial diagnosis was incorrect in this case, the use of sonography can aid in the prenatal detection and diagnosis of congenital diaphragmatic anomalies.     

Case of intercostal lung hernia with hemosputum that developed after thoracoscopic lobectomy

Intercostal lung hernia is defined as a protrusion of the lung tissue through a chest wall defect. It is an uncommon condition after a lobectomy, and most cases are asymptomatic. We herein report a case of intercostal lung hernia after a thoracoscopic right upper lobectomy in a patient whose chief complaint was hemosputum. Elevated intrathoracic pressure is a major risk factor for intercostal lung hernia. In this patient, obesity and bronchial asthma were considered the causes of this disease. Three reports on intercostal lung hernia after thoracoscopic lobectomy were previously published. In three of the four lung hernia cases (including our own), right upper lobectomy had been performed, and the middle lobe was herniated. We consider right upper lobectomy to be an anatomical risk factor.     

胎儿先天性膈疝产前超声筛查及妊娠结局分析

目的总结先天性膈疝（CDH）产前超声筛查结果及妊娠结局。 方法2014年1月至2017年12月大连市妇幼保健院产前超声诊断胎儿膈疝51例,总结膈疝胎儿超声声像图特点及相关妊娠结局。 结果产前超声筛查结果：51例疑诊胎儿中产前超声以胎儿腹围切面未发现胃泡为首发线索筛查出膈疝40例（78.4%,40/51）;以心脏移位、腹腔内胃泡位置和形态异常为首发线索筛查出膈疝9例（17.6%,9/51）;其中左侧43例（84.3%,43/51）,双侧5例（9.8%,5/51）,右侧1例（2.0%,1/51）;合并其他异常33例（64.7%,33/51）。超声诊断膈疝49例（96.1%,49/51）,误诊2例（3.9%,2/51,生后证实为膈膨升1例,肺囊腺瘤1例）。妊娠结局：51例超声检查后继续妊娠15例（29.4%,15/51）,肺头比（LHR）最小值为1.9,死亡6例（40.0%,6/15）,存活9例（60.0%,9/15）均接受手术治疗,愈后较好。 结论产前以胎儿腹围切面未发现胃泡、心脏移位、腹腔内胃泡位置及形态发生异常为线索诊断胎儿膈疝符合率较高;多学科会诊、产时干预和及时救治可提高先天性膈疝的生存率。     

Laparoscopic transabdominal preperitoneal hernioplasty for recurrent obturator hernia: A case report

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89‐year‐old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non‐mesh repair twice and then laparoscopic non‐mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.