Symptomatic right-sided diaphragmatic hernia in the third trimester of pregnancy.
BACKGROUND
Laparoscopic repair of incarcerated diaphragmatic hernias is widely recognized as both safe and effective. However, symptomatic diaphragmatic hernias encountered in the setting of pregnancy, while rare, present a significant surgical challenge. Furthermore, right-sided diaphragmatic hernias account for only 13% of cases. Here, we present a case in which a symptomatic, posterior right-sided diaphragmatic hernia, presenting in the later stages of pregnancy, was successfully repaired using a laparoscopic approach.


METHODS
Our patient is a 42-y-old gravid woman who, at 27 wk gestation, was admitted to the gynecology service with a 2-d history of right upper quadrant abdominal pain, right shoulder pain, abdominal distension, and obstipation.


RESULTS
Computed tomography of the chest demonstrated an incarcerated right diaphragmatic hernia. Surgical consultation was obtained, and the patient was taken to the operating room urgently for repair. Intraoperatively, the cecum was reduced and the diaphragm repaired primarily using a laparoscopic approach. The patient recovered well and was discharged home on postoperative day 8 with no complications to the patient or the pregnancy.


CONCLUSIONS
Laparoscopic reduction and repair of symptomatic incarcerated diaphragmatic hernia can be safely performed in the third trimester of pregnancy.
Department of Surgery, University of Missouri-Kansas City School of Medicine, KS City, MO, USA. wiemane@umkc.edu
Eric
E
Wieman
Graham
G
Pollock
B Todd
BT
Moore
Rosemarie
R
Serrone
D000328:Adult; D005260:Female; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011263:Pregnancy Trimester, Third; D014057:Tomography, X-Ray Computed