Abstract
A 62-year-old man underwent thoracoscopic partial hepatectomy via the diaphragm for hepatocellular carcinoma. Twenty-one months after the surgery, he began to complain of colicky upper abdominal pain and was brought to our emergency room. Abdominal X-ray showed small intestinal gas along with an abnormal gas collection in the right supradiaphragmatic space. Small bowel obstruction was diagnosed, and the patient was observed under “nothing nil by mouth”. His epigastralgia persisted for 4 days, and tenderness was found on palpation of the right upper quadrant. A repeat abdominal X-ray showed air-fluid levels and enlargement of the abnormal intrathoracic gas shadow. Intestinal obstruction due to incarceration of a diaphragmatic hernia was diagnosed and emergent surgery was performed, which revealed incarceration of the transverse colon and greater omentum at the diaphragmatic hernia orifice. The hernia orifice was the scar of the partial hepatectomy in the diaphragm. The possibility of iatrogenic diaphragmatic hernia should always be borne in mind in patients with a history of transdiaphragmatic surgery.
