title: Diaphragmatic hernia with strangulated loop of bowel presenting after colonoscopy: case report.
abstract: BACKGROUND
  The incidence of diaphragmatic hernias caused or exacerbated by diagnostic colonoscopy is not well elucidated at this time, and is believed to be very rare.
  
  
  METHODS
  We present the case of a 57 year old man with remote history of traumatic injury who first presented with vague left shoulder pain for two weeks, mild anemia, and tested positive for fecal occult blood. Four days post colonoscopy the patient was found to have a strangulated loop of bowel herniated through the diaphragm into the left hemithorax.
  
  
  CONCLUSIONS
  In patients with previous history of serious traumatic injury and particularly those with previous splenectomy, a thorough history and physical examination before routine colonoscopy is important. A high level of suspicion for post-operative complications should also be maintained when assessing such patients.
authors.affiliation: College of Medicine, University of Illinois at Urbana-Champaign, 190 Medical Sciences Building, 506 South Matthews Ave, Urbana, IL 61801, USA. samapth.kulasekhar@va.gov.
authors.forename: Sandeep S
authors.initials: SS
authors.lastname: Sodhi
authors.forename: Loren A
authors.initials: LA
authors.lastname: Zech
authors.forename: Vijay
authors.initials: V
authors.lastname: Batura
authors.forename: Sampath
authors.initials: S
authors.lastname: Kulasekhar