[Left strangulated diaphragmatic hernia: an unusual complication of gastric bypass]

The appearance of left strangulated diaphragmatic hernia doesn't seem to have been described in the past as a progressive complication after gastric bypass surgery. The authors describe the case of a 54 year old patient suffering from a strangulated gastric hernia pushing through a diaphragm defect located next to the gastric band. The gastric band had been placed two years previously in this patient suffering from morbid obesity. Strangulation of the hernia resulted in the sphacelation of the entire stomach fundus. Therefore a partial gastrectomy and removal of the band was necessary. Recovery from procedure was without complications. The past history of a major spinal trauma in this patient, could have led to a discussion regarding the etiology of this hernia, however the delay between the two events (28 years) makes this unlikely. It seems, therefore, that the placement of a gastric band was the responsible factor. The authors emphasize the importance of pre-procedure pulmonary X-ray, prior to any general anesthesia, as well as a post procedure cliché following any intervention that might have lead to diaphragmatic lesion.