A Case Report of Diaphragmatic Incisional Hernia Developed 18 Years after Plication of Diaphragmatic Eventration in Infancy

Abstract

Symptomatic diaphragmatic eventration in infants needs diaphragmatic plication, and its prognosis is almost favorable. A 19-year-old man operated on for diaphragmatic eventration in infancy visited our hospital for the sudden onset of left upper abdominal pain developed in playing Judo. The incarceration of a transverse colon into the left thoracic cavity side was detected by an enhanced CT scan. We diagnosed the case as diaphragmatic hernia and performed laparoscopic hernioplasty. The hernia orifice was identified on the suture line at the previous plication contained with vulnerable satellite lesions after reduction of the transverse colon and the greater omentum into the abdominal cavity. We considered that the elevation of abdominal pressure might cause the incarceration of the diaphragmatic incisional hernia. The intra-abdominal mesh repair was performed by covering primary-closed orifice and satellite lesions. He was discharged on postoperative day 8 without any surgical complications. There are no recurrent signs as of 1 year and 8 months after the operation.

In adult patients who had operated on for diaphragmatic eventration in infancy, we should recognize the risk of diaphragmatic hernia related to rapid elevation of abdominal pressure.