DIAPHRAGMATIC HERNIA AS A CONSEQUENCE OF A TRANSDIAPHRAGMATIC EPIPOPLASTY AS A TREATMENT OF A BRONCHOPLEURAL FISTULA

Abstract

Introduction: Diaphragmatic hernias whose source is different from the non traumatic transhiatal or traumatic (open or closed) are an exceptional pathology, with a scarce bibliography regarding the subject. It is for this matter that we present the following case report regarding a diaphragmatic hernia which source was a surgery performed to heal a bronchopleural fistula.

Case Report: The patient developed a fistula following a surgery to allow the closure of a bronchopleural fistula, in which a part of the omentum was ascended into the thoracic cavity in order to cover the bronchopleural fistula. Through that small incision where the omentum was ascended, an extensive diaphragmatic hernia was formed, which included the transverse colon, the spleen, gastric fundus and the pancreatic tail. The patient's clinic was primarily digestive: postpandrial plenitude, regurgitation and pyrosis. The patient underwent scheduled surgery in which a primary closure of the hernia was performed with a non-absorbable suture. The closure was reinforced with a Relimesh mesh adhered with sutures, tackers and glubran. The postoperative days went with no complications, and the patient was discharged. On the follow-up checks up to the 6^th month after the surgery, the patient has not shown any signs of relapse and has completely heal from the digestive clinic.

Conclussions: The diaphragmatic hernias of iatrogenic origin are exceptional on the usual clinical practice. Its treatment is no different from other kinds of diaphragmatic hernias, but they should be managed by team of surgeons specialized on esophagogastric surgery and vast experienced on the treatment of hiatal hernias.