A Case of Delayed Diaphragmatic Hernia Incarcerated 3 Years after Laparoscopic Deroofing of a Giant Liver Cyst

Abstract

The patient was an 83-year-old man. In October 2019, laparoscopic deroofing of a giant liver cyst with right upper quadrant pain was performed. The patient was discharged on postoperative day 8 without any complications.

Three years after the operation, in November 2022, he was examined with a chief complaint of left abdominal pain. Computed tomography (CT) showed a hernia of the right diaphragm and a decrease in the contrast enhancement effect of the small intestine. Delayed diaphragmatic hernia incarceration was diagnosed, and emergency surgery was performed on the same day. The abdominal cavity was observed laparoscopically. A thinned diaphragm was seen, and the small intestine was incarcerated from its dorsal side. Reduction of the small intestine from the abdominal cavity was difficult. When the thoracic cavity was observed with a thoracoscope, the small intestine with mesentery was prolapsed, and no hernial sac was observed. After thoracotomy, the hernia gate was enlarged, and the small intestine was reduced into the abdominal cavity. The hernia gate was closed with needle sutures using 2-0 non-absorbable threads.

The patient's postoperative course was uneventful, and he was discharged on postoperative day 12 without any complications.