A Long-term Asymptomatic Iatrogenic Diaphragmatic Hernia After Anterior Spinal Surgery

Abstract

An iatrogenic diaphragmatic hernia after anterior spinal surgery is very rare. A 66-years-old man underwent posterior spinal fusion for a spinal burst fracture 39 months earlier. However, 10 months after the surgery, he underwent posterior spinal fusion via the left thoracoabdominal approach due to bone union failure. Following the surgery, he was diagnosed as having a left diaphragmatic hernia. However, as he was asymptomatic, he was followed conservatively. At this time, he was admitted to our hospital with nausea, epigastric pain, and the emergence of lower bleeding. A CT scan showed that his stomach, colon, and spleen were incarcerated into the left thoracic cavity, and there was very poor enhancement of the colonic wall. An emergency laparotomy was performed. Intraoperatively, the strangulated colon and stomach revealed no ischemic signs and were reduced back into the abdominal cavity. Thereafter, the defect was repaired with a non-absorbable interrupted suture. We understood that an acute presentation with high index of suspicion for strangulated intestines may represent a diagnostic dilemma and require an emergency operation, even if a diaphragmatic hernia has been conservatively followed in an asymptomatic patient. Therefore, we recommend that even asymptomatic diaphragmatic hernias should be strictly and carefully observed or operated on, if the need arises.