title: A Rare Variant of Diaphragmatic Hernia through the Central Tendon: A Case Report.
abstract: Diaphragmatic hernia through the central tendon is a very rare entity. We report on a case that developed to acute intestinal obstruction, secondary to herniation of the small intestine through a small defect in the central tendon of the diaphragm. The patient never had any trauma to his chest or abdomen and had no history suggestive of congenital nature of the diaphragmatic hernia. However, he had coronary artery bypass grafting with saphenous vein used as a graft, done almost 17 years back; hence, we suspect it to be an iatrogenic hernia. A laparoscopic herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. Iatrogenic diaphragmatic hernias are a very rare entity. We are reporting on a central tendon hernial defect in the diaphragm after coronary artery bypass with saphenous vein as a graft material. There are reported cases with post coronary artery bypass graft diaphragmatic hernia in which the right gastroepiploic artery was taken as the graft material. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. CT scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients.
authors.affiliation: Department of Minimal Access and Bariatric Surgery, ILS Hospitals, DD-6, Salt Lake City, Sector 1, Kolkata, 700064 India.
authors.forename: Digant
authors.initials: D
authors.lastname: Pathak
authors.affiliation: Department of Minimal Access and Bariatric Surgery, ILS Hospitals, DD-6, Salt Lake City, Sector 1, Kolkata, 700064 India.
authors.forename: Om
authors.initials: O
authors.lastname: Tantia
authors.affiliation: Department of Minimal Access and Bariatric Surgery, ILS Hospitals, DD-6, Salt Lake City, Sector 1, Kolkata, 700064 India.
authors.forename: Tamonas
authors.initials: T
authors.lastname: Chaudhuri
authors.affiliation: Department of Minimal Access and Bariatric Surgery, ILS Hospitals, DD-6, Salt Lake City, Sector 1, Kolkata, 700064 India.
authors.forename: Jagat Pal
authors.initials: JP
authors.lastname: Singh
keywords: Central tendon of the diaphragm; Diaphragm injury; Iatrogenic diaphragmatic hernia; Intrapericardial diaphragmatic hernia; Laparoscopic repair