A DOUBLE LAPAROSCOPIC AND THORACOSCOPIC APPROACH IN A CASE OF ADULT DIAPHRAGMATIC HERNIA

Alin Burlacu; Cosmin Bogdan Tănase; Mara Mardare; Mihai Mugescu; Theodor Horvat; Octav Ginghină

Alin Burlacu Thoracic Surgery Department of "Prof. dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
Cosmin Bogdan Tănase Thoracic Surgery Department of "Prof. dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
Mara Mardare "Prof. dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
Mihai Mugescu Thoracic Surgery Department of "Prof. dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania
Theodor Horvat Thoracic Surgery Department of "Prof. dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
Octav Ginghină "Prof. dr. Alexandru Trestioreanu" Institute of Oncology Bucharest, Romania & "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania

Keywords: diaphragmatic hernia, diaphragmatic rupture, laparoscopy, thoracoscopy, combined approach

Abstract

A diaphragmatic hernia (DH) is a protrusion of abdominal contents into the thoracic cavity due to a defect within the diaphragm. It is most common as a congenital phenomenon; however, there have also been cases where it can be acquired. A missed diaphragmatic injury may result in delayed herniation and strangulation of abdominal organs into the thoracic cavity through the unrepaired defect in the diaphragm. We present a case of a 37-year-old male admitted to our clinic for dyspnea and thoracic pain on the left side. Clinical examination revealed decreased intensity of breath sounds and dullness to percussion at the level of the lower chest. Chest X-ray shows a left lower lobe inhomogeneous opacity. Thorax and abdominal computed tomography reveal a huge diaphragmatic hernia with the protrusion in the left chest cavity of the colon, omentum, pancreatic tail; consequent left lower pulmonary lobe atelectasis was noted. Surgical treatment was the only solution: we used right lateral decubitus; we performed abdominal organs reposition and diaphragm suture via combined laparoscopic and thoracoscopic approach with good results. We report a case of an old diaphragmatic rupture with increased symptomatology in the last 3 months before admission. Because of the pleural adhesions, we opted for a combined laparoscopic and thoracoscopic approach, which proved to be a success.

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