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Intrathoracic gastric perforation: a late complication of an unknown postpartum recurrent hiatal hernia.
Interact Cardiovasc Thorac Surg. 2012 Aug; 15(2):317-8.IC

Abstract

Diaphragmatic hernias occurring during pregnancy are an uncommon event. In very rare occasions, the clinical situation can suddenly worsen due to obstruction, torsion or infarction of the herniated viscera. Here, we describe a challenging case of a post-partum diaphragmatic hiatus hernia complicated by intrathoracic gastric perforation. A 23-year old woman was admitted at our hospital with a syndrome characterized by epigastralgy, dyspnoea and fever. She had previously undergone a laparoscopic antireflux surgery for hiatus hernia (6 years before) and a recent (4 months) unremarkable vaginal delivery. Due to the persistence of a pelvic pain after the delivery, she had been taking pain-killers as a self-administered medication. A CT scan showed a massive left pleural effusion and a complete herniation of the stomach into the left hemithorax. After placing a chest drainage and removing up to 3000 ml of brownish purulent fluid, a repeat CT scan (with water soluble contrast swallow) showed a leak at the level of the stomach. At surgery, we observed a complete intrathoracic herniation through a large diaphragmatic hiatal defect and a small well-defined gastric ulcer. A primary repair of both the stomach and the diaphragm was performed. We take the opportunity presented by this report to briefly discuss the patho-physiological mechanisms underlying this unusual complication.

Authors+Show Affiliations

Department of General Thoracic Surgery, Catholic university of Sacred Heart, Rome, Italy. filippo_lococo@yahoo.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22611183

Citation

Lococo, Filippo, et al. "Intrathoracic Gastric Perforation: a Late Complication of an Unknown Postpartum Recurrent Hiatal Hernia." Interactive Cardiovascular and Thoracic Surgery, vol. 15, no. 2, 2012, pp. 317-8.
Lococo F, Cesario A, Meacci E, et al. Intrathoracic gastric perforation: a late complication of an unknown postpartum recurrent hiatal hernia. Interact Cardiovasc Thorac Surg. 2012;15(2):317-8.
Lococo, F., Cesario, A., Meacci, E., & Granone, P. (2012). Intrathoracic gastric perforation: a late complication of an unknown postpartum recurrent hiatal hernia. Interactive Cardiovascular and Thoracic Surgery, 15(2), 317-8. https://doi.org/10.1093/icvts/ivs209
Lococo F, et al. Intrathoracic Gastric Perforation: a Late Complication of an Unknown Postpartum Recurrent Hiatal Hernia. Interact Cardiovasc Thorac Surg. 2012;15(2):317-8. PubMed PMID: 22611183.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intrathoracic gastric perforation: a late complication of an unknown postpartum recurrent hiatal hernia. AU - Lococo,Filippo, AU - Cesario,Alfredo, AU - Meacci,Elisa, AU - Granone,Pierluigi, Y1 - 2012/05/18/ PY - 2012/5/22/entrez PY - 2012/5/23/pubmed PY - 2012/12/10/medline SP - 317 EP - 8 JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg VL - 15 IS - 2 N2 - Diaphragmatic hernias occurring during pregnancy are an uncommon event. In very rare occasions, the clinical situation can suddenly worsen due to obstruction, torsion or infarction of the herniated viscera. Here, we describe a challenging case of a post-partum diaphragmatic hiatus hernia complicated by intrathoracic gastric perforation. A 23-year old woman was admitted at our hospital with a syndrome characterized by epigastralgy, dyspnoea and fever. She had previously undergone a laparoscopic antireflux surgery for hiatus hernia (6 years before) and a recent (4 months) unremarkable vaginal delivery. Due to the persistence of a pelvic pain after the delivery, she had been taking pain-killers as a self-administered medication. A CT scan showed a massive left pleural effusion and a complete herniation of the stomach into the left hemithorax. After placing a chest drainage and removing up to 3000 ml of brownish purulent fluid, a repeat CT scan (with water soluble contrast swallow) showed a leak at the level of the stomach. At surgery, we observed a complete intrathoracic herniation through a large diaphragmatic hiatal defect and a small well-defined gastric ulcer. A primary repair of both the stomach and the diaphragm was performed. We take the opportunity presented by this report to briefly discuss the patho-physiological mechanisms underlying this unusual complication. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/22611183/Intrathoracic_gastric_perforation:_a_late_complication_of_an_unknown_postpartum_recurrent_hiatal_hernia_ L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivs209 DB - PRIME DP - Unbound Medicine ER -