Limits...
Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax.

Lingohr P, Galetin T, Vestweber B, Matthaei H, Kalff JC, Vestweber KH - Int Med Case Rep J (2014)

Bottom Line: Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare.For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur.As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Bonn, Bonn, Germany.

ABSTRACT

Purpose: Diaphragmatic hernias (DHs) are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur.

Methods: In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant.

Results: As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax.

Conclusion: We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan of the thorax showing a complete enterothorax (arrows).Abbreviations: A, anterior; L, left; P, posterior; R, right.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3928060&req=5

f1-imcrj-7-023: Computed tomography scan of the thorax showing a complete enterothorax (arrows).Abbreviations: A, anterior; L, left; P, posterior; R, right.

Mentions: As the patient was suffering from progredient dyspnea, a computed tomography was performed, which showed a complete enterothorax (Figure 1); therefore, an operative approach was indicated. The upper abdomen was incised by transverse laparotomy revealing a large package of small intestine ventrally disappearing on both sides of the chest (Figure 2). The adhesions were divided and the parts of the colon and jejunum that were dislocated in the chest were repositioned into the abdomen. Some parts were partially strangulated but still in good shape. The stomach, however, was in the correct anatomical location. After repositioning and resection of the hernial sac, the hernial gap could hardly be adapted (Figure 3). The diaphragm was very weak, which suggested that a direct closure would be too fragile. For this reason, a large flap of PERMACOL™ (original size: 18 cm ×28 cm ×1.5 cm; Covidien Ltd, Dublin, Ireland) was trimmed to fit so that it covered both sides of the dorsal diaphragm and the ventral part of the flap overlapped with the abdominal wall incision (Figure 4). The flap was fixed all around with VICRYL™ 0 sutures (Johnson & Johnson, New Brunswick, NJ, USA; Figure 5). As a pneumothorax on the right side was provoked by the manipulation, thoracic drainage was applied. The abdominal wall was occluded involving the ventral edge of the PERMACOL™ flap to provide for more stability.


Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax.

Lingohr P, Galetin T, Vestweber B, Matthaei H, Kalff JC, Vestweber KH - Int Med Case Rep J (2014)

Computed tomography scan of the thorax showing a complete enterothorax (arrows).Abbreviations: A, anterior; L, left; P, posterior; R, right.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928060&req=5

f1-imcrj-7-023: Computed tomography scan of the thorax showing a complete enterothorax (arrows).Abbreviations: A, anterior; L, left; P, posterior; R, right.
Mentions: As the patient was suffering from progredient dyspnea, a computed tomography was performed, which showed a complete enterothorax (Figure 1); therefore, an operative approach was indicated. The upper abdomen was incised by transverse laparotomy revealing a large package of small intestine ventrally disappearing on both sides of the chest (Figure 2). The adhesions were divided and the parts of the colon and jejunum that were dislocated in the chest were repositioned into the abdomen. Some parts were partially strangulated but still in good shape. The stomach, however, was in the correct anatomical location. After repositioning and resection of the hernial sac, the hernial gap could hardly be adapted (Figure 3). The diaphragm was very weak, which suggested that a direct closure would be too fragile. For this reason, a large flap of PERMACOL™ (original size: 18 cm ×28 cm ×1.5 cm; Covidien Ltd, Dublin, Ireland) was trimmed to fit so that it covered both sides of the dorsal diaphragm and the ventral part of the flap overlapped with the abdominal wall incision (Figure 4). The flap was fixed all around with VICRYL™ 0 sutures (Johnson & Johnson, New Brunswick, NJ, USA; Figure 5). As a pneumothorax on the right side was provoked by the manipulation, thoracic drainage was applied. The abdominal wall was occluded involving the ventral edge of the PERMACOL™ flap to provide for more stability.

Bottom Line: Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare.For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur.As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University of Bonn, Bonn, Germany.

ABSTRACT

Purpose: Diaphragmatic hernias (DHs) are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur.

Methods: In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant.

Results: As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax.

Conclusion: We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue.

No MeSH data available.


Related in: MedlinePlus