[Late traumatic diaphragmatic hernia complicated by intrathoracic perforation and haemorrhagic gastric cyst: a rare combination].
The authors describe the clinical and imagiologic challenges faced at the Emergency Room while observing a 48-year-old woman, submitted to a Nissen fundoplication 16 months earlier. She presented herself with a one-month total progressive dysphagia, epigastric pain and regurgitation. Intraoperative findings demonstrated an intraabdominal fundoplication, closure of diaphragmatic crura and part of the gastric greater curvature and body herniated through a small posterior defect on the diaphragm, with a gigantic serosal cystic mass and associated perforation. Data from posterior clinical investigation shows a traffic accident 34 years ago. Although described before, the association of late traumatic diaphragmatic hernia and gastric intrathoracic perforation is rare (< 2.5%) and difficult to diagnose. A revision of the literature is performed concerning the pathophysiologic mechanisms of late diaphragmatic rupture, its clinical presentation and diagnosis, as for Nissen fundoplication complications, its prevention and management.
Rafael
Ana Alves
AA
Serviço de Cirurgia II, Hospital Egas Moniz, S.A., Lisboa.
Rodrigues
Patrícia
P
Carmo
Leonor do
Ld
Nascimento
Carlos
C
Machado
Juliano
J
Fonseca
J Rosado da
JR
D003560:Cysts / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications*; D006548:Hernia, Diaphragmatic / Q000150:complications* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012422:Rupture, Spontaneous; D013272:Stomach Diseases / Q000150:complications*; D013997:Time Factors