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Isolated trans-hiatal colonic herniation.

Joshua Felsher1, Jason Brodsky, Fred Brody

  • 1Minimally Invasive Surgery Center, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|May 10, 2003
PubMed
Summary
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This case report details a rare instance of isolated colon herniation through the diaphragm without stomach displacement. Laparoscopic repair was successfully performed, offering a minimally invasive treatment option for this unusual condition.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Diaphragmatic Surgery

Background:

  • Diaphragmatic defects can lead to organ herniation, with colonic involvement being documented.
  • Trans-hiatal herniation of the colon, particularly without concurrent gastric herniation, is exceptionally rare.

Observation:

  • A 67-year-old male presented with abdominal pain and a mediastinal air-fluid level suggestive of thoracic gastrointestinal contents.
  • Imaging studies confirmed transverse colon within the thoracic cavity, while the stomach remained in its normal position.

Findings:

  • The patient underwent successful laparoscopic repair of the diaphragmatic defect and the isolated transverse colon herniation.
  • A Toupet fundoplication and gastropexy were performed due to esophageal dissection during the antireflux procedure.

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Implications:

  • This case highlights a rare congenital diaphragmatic anomaly allowing isolated colonic herniation.
  • Laparoscopic repair represents a feasible and effective approach for this uncommon surgical presentation.
  • The intact gastric mesentery and posterior gastric attachments were crucial in preventing simultaneous stomach herniation.