Management of strangulated, perforated gastrothorax with resultant tension pneumothorax secondary to an iatrogenic diaphragmatic hernia: a case report.

Abstract

Diaphragmatic hernias arise when a defect in the diaphragmatic musculotendinous framework allows the abnormal protrusion of abdominal contents into the thoracic cavity, which can be further complicated by visceral incarceration, strangulation, and perforation. Whilst the vast majority occur congenitally or are acquired through trauma, diaphragmatic hernias arising from iatrogenic insults represent an exceedingly rare but important clinical entity. Diagnostic challenges arise in large part due to their tendency towards delayed presentation, often with varied, nonspecific and subacute clinical manifestations, as well as equivocal or indeterminate radiographic findings. The report herein represents the inaugural account of an iatrogenic diaphragmatic hernia arising following thoracoscopic pleural endometriosis removal, which was subsequently complicated by gastric strangulation and perforation, culminating in a life-threatening tension pneumothorax. We describe a safe, effective approach to managing this surgical emergency using an entirely laparoscopic technique and relate our findings to the broader literature pertaining to complicated diaphragmatic hernias.