Esther Wu, MD, Manuel Garcia, MD, Jeffrey Quigley, DO, Stephanie Keeth, DNP, Aarthy Kannappan, MD, Daniel Srikureja, MD, Marcos Michelotti, MD, FACS, Keith Scharf, DO, FACS, FASMBS, Crystal Alvarez, DO. Loma Linda University Health
Iatrogenic diaphragmatic hernia after thoracic surgery is a rare occurrence. To date, only a few cases have been reported1. More commonly, iatrogenic diaphragmatic hernias occur after trauma and gastroesophageal surgeries2. Diaphragmatic injuries have also been described after thoracic spine surgery3. We present here a video case report of a 19-year-old female who had undergone left thoracotomy and exploratory laparotomy for debulking of metastatic ganglioneuroblastoma. She developed intractable nausea and emesis 6 months later while in the midst of her chemotherapy treatment. Work up, including CT scan, revealed a new onset left sided diaphragm hernia with gastric incarceration as well as organo-axial volvulus. Patient was resuscitated and taken to operating room for urgent repair. Robotic technology was employed (Da Vinci Si, Intuitive, CA). The hernia defect was identified and the stomach reduced back into the abdomen. An upper endoscopy was performed to ensure the stomach remained viable. A composite mesh was then anchored to the left diaphragm to interpose the defect as it was too large for primary repair. The mesh consists of two layers of biosynthetic material sandwiching a macroporous polytetrafluoroethylene (PTFE) mesh. The patient recovered well from surgery and was resumed on a diet prior to discharge home four days later. She resumed her oncologic treatment without difficulty. Her images one month later revealed a normal left sided diaphragm morphology with mesh intact. Laparoscopic approach for diaphragm hernia repair has been described frequently in literature. However, use of robotic technique in an urgent situation has not been described. In addition, the application of a biosynthetic PTFE composite mesh has never been reported. Our case represents the first ever use of the above techniques in an acute gastric volvulus due to an iatrogenic diaphragmatic injury.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88077
Program Number: V186
Presentation Session: Wednesday Video Loop (Non CME)
Presentation Type: VideoLoop