Unusual delayed presentation of post-traumatic intrapericardial hernia associated with intestinal occlusion

We report a case of a 64-year-old man, admitted to our department following the onset a few months earlier of canalization disorders and a sensation of retrosternal tension.

Patient's history revealed blunt thoraco-abdominal trauma with multiple costal fractures 15 years earlier as a result of a road accident and a cholecystectomy at the age of 57. A barium meal revealed an intrapericardial displacement of some intestinal loops; as the patient suffered acute intestinal occlusion with severe abdominal pain associated with nausea and vomiting, we performed an emergency median xipho-umbilical laparotomy, making it possible to identify both the site of the retrosternal diaphragmatic laceration with intrapericardial colonic herniation and the true cause of the occlusion: an adhesion, caused by the previous cholecistectomy, which was strangulating a jejunal loop. After detaching the adhesion between the colon and the pericardium, the viscera were replaced in the abdominal cavity and the diaphragmatic opening was closed.

The post-operative period was uneventful; a barium enema demonstrated the abdominal dislocation of the viscera. No recurrence was detected during the 48 months of follow-up.

A rare pathological event, such as an intrapericardial diaphragmatic hernia, was combined with intestinal occlusion, initially attributed to a further complication of the hernia itself but in actual fact independent of the hernia and a consequence of a previous cholecystectomy.