Combined minimally invasive approach for an incarcerated diaphragmatic hernia with a perforated stomach in a young adult female - A video case report

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INTRODUCTION: Diaphragmatic hernia is most commonly congenital; however, it can also be acquired, most often due to trauma. It is a life-threatening condition resulting in abdominal visceral incarceration and subsequent mortality. PRESENTATION OF CASE: Our patient was a 27-year-old mother who presented with upper abdominal pain associated with breathlessness. There was no history of trauma. The chest X-ray suggested the diagnosis of a diaphragmatic hernia which was further confirmed on CT. The decision was made to operate on the patient through a laparoscopic approach using single-lung ventilation. A diaphragmatic rent was identified with the incarceration of the stomach and omentum. The rent was widened further which allowed partial reduction of contents and visualization of the left hemithorax which was entirely contaminated. An additional thoracic approach was opted for which enabled reduction of the herniated stomach. A large perforation was present along the greater curvature, which was resected using a linear endo stapler. The diaphragmatic rent was then repaired primarily. Adequate lavage, aspiration, and mopping were performed along with chest tube drainage. The patient remained stable post-operatively. DISCUSSION: An optimal surgical repair along with sound perioperative care is essential for the successful management of diaphragmatic hernia. A minimally invasive approach avoided extensive open surgery and the complications that would come with it for a young nursing mother. CONCLUSION: Such technically challenging cases can be successfully managed with a minimally invasive approach using sound surgical skills and necessary improvisations.

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