Usefulness of Plain Computed Tomography with Swallowing of GastrografinTM for the Diagnosis of a Late-Onset Iatrogenic Diaphragmatic Hernia following Biopsy of a Diaphragmatic Tumor: Report of a Case

Case Reports in Gastroenterology
Yoh AsahiAkinobu Taketomi

Abstract

Although diaphragmatic hernia (DH) may be congenital, posttraumatic, or iatrogenic, DHs after diaphragmatic surgery are rarely reported in the literature. This report describes the rare case of a 14-year-old girl complicated by iatrogenic DH following the biopsy of granulomatous lesions of the left diaphragm, when a mediastinal mixed germ cell tumor was extirpated. Plain computed tomography (CT) with swallowing of GastrografinTM was useful for the diagnosis of this disorder. The patient presented to our hospital with frequent epigastric pain and vomiting 11 months after the original surgery. Chest X-ray, a gastrointestinal contrast study, and plain CT with swallowing of GastrografinTM revealed the left DH with gastric content. At laparotomy, the diaphragmatic defect, 3 × 3 cm in diameter, was repaired using nonabsorbable sutures after hernia reduction. The patient showed a rapid recovery with complete resolution of symptoms. We should consider the presence of iatrogenic DH in patients who develop epigastralgia after procedures involving the diaphragm, even at 11 months after the original surgery. Furthermore, plain CT with swallowing of GastrografinTM is useful for the diagnosis of this disorder.

References

Nov 1, 1995·The Annals of Thoracic Surgery·R ShahA K Choudhury
Feb 23, 1999·The British Journal of Surgery·J W van SandickH Obertop
Aug 3, 1999·Surgical Endoscopy·P A ArmstrongG R Brown
Apr 19, 2000·Journal of Pediatric Surgery·C T RamosS H Ein
Sep 25, 2002·ANZ Journal of Surgery·Ronald Y ChinPeter Brady
May 1, 2008·Hernia : the Journal of Hernias and Abdominal Wall Surgery·V E de MeijerP T den Hoed
May 8, 2008·Obesity Surgery·Stephen BoyceChris Shearer
Jul 17, 2008·European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [et Al] = Zeitschrift Für Kinderchirurgie·M BettolliS Rubin
Aug 28, 2009·Hernia : the Journal of Hernias and Abdominal Wall Surgery·F E MuysomsD A B Claeys

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Methods Mentioned

BETA
biopsy
X-ray

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