Diaphragmatic Hernia an Uncommon Complication of Left Hemicolectomy for Colonic Adenocarcinoma

Author(s): Dallas E Kramer, Marcus Eby, Andrew Arndt

Background: Acquired diaphragmatic hernia is a rare complication of surgery. Treatment is surgical repair of the defect, which may be accomplished by an abdominal or thoracic approach. We report the second case of iatrogenic diaphragmatic hernia following left hemicolectomy, and the first case managed with a thoracic approach.

Case presentation: An 89-year-old male who underwent left hemicolectomy for colonic adenocarcinoma and presented to the emergency department on postoperative day (POD) 44 with repeated emesis and obstipation. Abdominal CT demonstrated a left anterior diaphragm defect with associated small bowel herniation and obstruction. The patient underwent left muscle-sparing thoracotomy with successful reduction of the herniated bowel and repair of the diaphragmatic defect.

Conclusions: Acquired diaphragmatic hernia is a rare complication of surgery. A thoracic approach may be preferred when there exists concern for extensive abdominal adhesions, such as in cases of delayed time to presentation.