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Intrapericardial diaphragmatic hernia. A case report.

M J Laric, M Roger, H B Broude

South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie

|July 1, 1989

Summary

A rare case of intrapericardial diaphragmatic hernia following blunt trauma presented with gastric outlet obstruction. Despite surgical repair with a mesh graft, complications led to a fatal outcome, highlighting the condition's severity.

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Area of Science:

Trauma Surgery
Thoracic Surgery
Gastroenterology

Background:

Intrapericardial diaphragmatic hernia is a rare condition, often resulting from blunt or penetrating trauma.
Presentation can be insidious, with symptoms mimicking gastrointestinal or cardiac issues.

Observation:

A patient with blunt trauma developed an intrapericardial diaphragmatic hernia, presenting with gastric outlet obstruction.
Pre-operative diagnosis was achieved using plain chest radiography and barium swallow examination.
Surgical intervention involved laparotomy with Marlex mesh-graft repair due to the large diaphragmatic defect.

Findings:

Postoperative complications included hydropneumopericardium, pericarditis, and cardiac arrhythmias.
The patient succumbed to these complications despite intensive medical management.

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This case underscores the potential for severe morbidity and mortality associated with this injury.

Implications:

Early diagnosis and prompt surgical management are crucial for intrapericardial diaphragmatic hernias.
The rarity and potential for fatal outcomes necessitate increased awareness among clinicians.
Reviewing such cases aids in understanding and improving treatment strategies for diaphragmatic injuries.