title: Iatrogenic diaphragmatic hernia complicating nephrectomy: top-down or bottom-up?
abstract: Hernias of the diaphragm are rarely reported as a complication of abdominal surgery. We review a case of a 47-year-old female who presented with dyspnoea and chest pain one day after left radical nephrectomy for renal cell carcinoma. Plain and cross-sectional imaging identified a large left-sided diaphragmatic hernia containing omentum, spleen, splenic flexure, and stomach. Our patient underwent a thoracotomy and, after hernia reduction, the diaphragmatic defect was repaired using non-absorbable sutures and a mesh. She made an uneventful recovery. The potential cause is discussed and the published literature on this rare complication is reviewed briefly.
authors.affiliation: Department of Surgery, Ikazia Hospital Rotterdam, P.O. Box 5009, 3008 AA, Rotterdam, The Netherlands.
authors.forename: V E
authors.initials: VE
authors.lastname: de Meijer
authors.forename: W J
authors.initials: WJ
authors.lastname: Vles
authors.forename: E
authors.initials: E
authors.lastname: Kats
authors.forename: P T
authors.initials: PT
authors.lastname: den Hoed
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery; D005260:Female; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007680:Kidney Neoplasms / Q000601:surgery; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications; D014057:Tomography, X-Ray Computed