A Diaphragmatic Hernia With Strangulated Ileus After Hepatectomy

Abstract

A 74-years-old woman had undergone a hepatectomy for hepatocellular carcinoma in March, 2014. Seven months after the surgery, she began to complain of nausea and abdominal pain and was brought to our hospital. Chest X-ray showed an abdominal gas shadow above the right diaphragm and contrast enhanced CT showed herniation and bad contrast of the intestinal tract into the right thoracic cavity. We diagnosed a diaphragmatic hernia based on these findings. We performed an emergency operation, which revealed incarceration of the terminal ileum at the hernia orifice. After prolapsed terminal ileum was replaced into the abdominal cavity, the diaphragmatic hernia orifice was repaired. The postoperative course was good. The hernia orifice was the scar of the hepatectomy in the diaphragm. Iatrogenic diaphragmatic post-hepatectomy hernias are rare, however, diaphragmatic hernias with an extremely poor prognosis have been reported. Therefore, diaphragmatic hernia formation is one of the postoperative complications which should be considered after a hepatectomy.