John R Frederick, MD, Kenric Murayama, MD. University of Pennsylvania School of Medicine
Summarry of surgical case:
72 year-old male with a past medical history of asthma and GERD presented to the ER complaining of nausea and vomiting associated with chest pain and dyspnea. His emesis contained both fresh and clotted blood. Objective findings included normal vital signs, decreased breath sounds at the right lung base, and a normal abdominal exam. Laboratory studies were remarkable for a mild leukocytosis and elveated serum creatinine. Chest radiographs and computed tomographic imaging of the chest revealed abdominal contents including the stomach and transverse colon in the right chest consistent with a diaphragmatic hernia of Morgagni.
The patient was managed with nasogastric decompression and bowel rest. A subsequent EGD showed viable gastric mucosa with obstruction at the diaphragmatic defect.
The patient was taken to the operating room the next day for a laparoscopic diaphragmatic hernia repair. The hernia sac was dissected free at the edges of the defect as well as the pleura. A 16 french extrapleural drain was placed in the supra-diaphragmatic space. A dual-sided, synthetic porous mesh was used for the repair. This was fixed to the anterior chest wall with permanent sutures secured around the 10th and 11th ribs and a spiral tacker, and the posterior aspect was sutured to the free edge of the diaphragm. The patient experienced no postoperative complications and was discharged home on postoperative day 4. Surveillance imaging at that time and 4 weeks post-operatively revealed an intact repair with successful reduction of abdominal contents and a fully expanded right lung.
Session Number: VidTV3 – Video Channel Rotation Day 3
Program Number: V127
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