title: Iatrogenic diaphragmatic hernia following laparoscopic left colectomy for splenic flexure cancer An unusual complication.
abstract: Iatrogenic diaphragmatic hernia following laparoscopic left colectomy for splenic flexure cancer. An unusual complication Diaphragmatic hernias are a migration of abdominal structures into the thorax via a diaphragmatic defect; they may be classified as congenital or acquired and acquired hernias can be hiatal, traumatic or iatrogenic, generally complications of thoracic or abdominal surgery. We report a case of iatrogenic diaphragmatic hernia after a laparoscopic left colectomy for splenic flexure tumor; to our knowledge, in literature this case is the first reported. A 51-years-old woman was readmitted to our Hospital on 11th post-operative day for bowel occlusion and a CT - scan revealed left diaphragmatic herniation with fluid dilatation of the small bowel that appeared in the left hemithorax. Laparoscopic surgery resolution was decided and after the reduction of the small bowel in the abdomen we closed the defect using two direct absorbable auto-block hemi-continuous sutures that were covered by a synthetic absorbable mesh. Probably we didn't notice a minimal injury of the left diaphragm caused by ultrasonic scalpel and we can suppose that this delay in presentation may be a result of the gradual enlargement of a microscopic lesion. Patient's gas exchanges were good during surgery and during post-operative course.
  
  
  BACKGROUND
  Diaphragmatic hernia, Iatrogenic, Laparoscopy, Left colectomy, Ultrasonic scalpel.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dell'Abate
authors.forename: Elisa
authors.initials: E
authors.lastname: Bertocchi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Dalla Valle
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Viani
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Rio
authors.forename: Mario
authors.initials: M
authors.lastname: Sianesi
mesh_terms: D003082:Colectomy / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000601:surgery*; D003964:Diaphragm / Q000293:injuries*; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D001261:Pulmonary Atelectasis / Q000209:etiology; D013526:Surgical Mesh; D013536:Suture Techniques; D014057:Tomography, X-Ray Computed; D059708:Ultrasonic Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation