title: Dual mesh repair for a large diaphragmatic hernia defect: An unusual case report.
abstract: BACKGROUND
  Diaphragmatic hernia secondary to traumatic rupture is a rare entity which can occur after stab wound injuries or blunt abdominal traumas. We aimed to report successfully management of dual mesh repair for a large diaphragmatic defect.
  
  
  METHODS
  A 66-year-old male was admitted with a right sided diaphragmatic hernia which occurred ten years ago due to a traffic accident. He had abdominal pain with worsened breath. Chest X-ray showed an elevated right diaphragm. Further, thoraco-abdominal computerized tomography detected herniation a part of the liver, gallbladder, stomach, and omentum to the right hemi-thorax. It was decided to diaphragmatic hernia repair. After an extended right subcostal laparotomy, a giant right sided diaphragmatic defect measuring 25×15cm was found in which the liver, gallbladder, stomach and omentum were herniated. The abdominal organs were reducted to their normal anatomic position and a dual mesh graft was laid to close the diaphragmatic defect. Patients' postoperative course was uneventful.
  
  
  CONCLUSIONS
  Diaphragmatic hernia secondary to trauma is more common on the left side of the diaphragm (left/right=3/1). A right sided diaphragmatic hernia including liver, stomach, gallbladder and omentum is extremely rare. The main treatment of diaphragmatic hernias is primary repair after reduction of the herniated organs to their anatomical position. However, in the existence of a large hernia defect where primary repair is not possible, a dual mesh should be considered.
  
  
  CONCLUSIONS
  A dual mesh repair can be used successfully in extensive large diaphragmatic hernia defects when primary closure could not be achieved.
authors.affiliation: Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey.
authors.forename: Metin
authors.initials: M
authors.lastname: Ercan
authors.affiliation: Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey. Electronic address: mhmtaziret@gmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aziret
authors.affiliation: Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey.
authors.forename: Kerem
authors.initials: K
authors.lastname: Karaman
authors.affiliation: Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey.
authors.forename: Birol
authors.initials: B
authors.lastname: Bostancı
authors.affiliation: Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey.
authors.forename: Musa
authors.initials: M
authors.lastname: Akoğlu
keywords: Diaphragm hernia; Dual mesh; Traumatic diaphragm rupture