Delayed iatrogenic diaphragmatic hernia after thoracoscopic lobectomy

Area of Science:

• Thoracic Surgery
• Surgical Complications
• Gastrointestinal Surgery

Background:

• Postoperative diaphragmatic hernias are rare complications following thoracic surgery.
• Video-assisted thoracic surgery (VATS) lobectomy is a common procedure for lung cancer.
• Delayed presentation of iatrogenic diaphragmatic hernias can be challenging to diagnose.

Observation:

• A 55-year-old female developed a diaphragmatic hernia with gastric perforation months after VATS left upper lobectomy.
• Symptoms included nausea and vomiting, prompting readmission and investigation.
• Intraoperative findings revealed significant inflammatory adhesions through the diaphragmatic defect.

Findings:

• Urgent laparotomy was performed for the diaphragmatic hernia and gastric perforation.
• Choledochoscopy was utilized through the diaphragmatic defect to manage adhesions and achieve hemostasis.
• This approach proved efficient and feasible for managing complex cases.

Implications:

• Delayed diaphragmatic hernia should be considered in patients with gastrointestinal symptoms post-VATS.
• The use of choledochoscopy offers a novel approach for managing intrathoracic adhesions in such cases.
• This case underscores the importance of vigilance for rare complications after thoracic procedures.