title: Tension hemothorax following abdominal surgery - a rare presentation of congenital diaphragmatic defect.
abstract: BACKGROUND
  Small congenital diaphragmatic defects are usually occult, but can present as a problem in patients with increased abdominal fluid as unilateral massive hydrothorax. We present a unique case presentation of a small congenital diaphragmatic defect.
  
  
  METHODS
  A 79 female immediately postoperatively developed a hydrothorax following low anterior resection for rectal cancer. The hydrothorax turned out to be due to an intrabdominal bleed in a patient with a previously undiagnosed congenital diaphragmatic hernia. The respiratory ball value mechanism worked as a pump to move blood from the abdomen to the chest and caused a tension hemothorax.
  
  
  RESULTS
  Surgeons should be aware that a post operative hydrothorax could be associated with an intrabdominal complication of recent surgery.
  
  
  CONCLUSIONS
  A small occult congenital diaphragmatic defect and associated ball value mechanism may provide an unexpected but clinically significant communication between the abdominal and thoracic cavities.
authors.affiliation: Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand.
authors.forename: C K
authors.initials: CK
authors.lastname: Choong
authors.forename: G N
authors.initials: GN
authors.lastname: Coulter
authors.forename: F A
authors.initials: FA
authors.lastname: Frizelle
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D005260:Female; D006491:Hemothorax / Q000209:etiology*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D013514:Surgical Procedures, Operative / Q000009:adverse effects*