Repair of diaphragmatic hernia following spinal surgery by laparoscopic mesh application: a case report and review of the literature

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• 作者：Roberto Bini (1)
  Diego Fontana (1)
  Alessandro Longo (2)
  Paolo Manconi (1)
  Renzo Leli (1)
  
  1. Department of Surgery ; SG Bosco Hospital ; Piazza del donatore di Sangue 3 ; 10153 ; Turin ; Italy
  2. Department of Neurosurgery ; SG Bosco Hospital ; Piazza delm donatore del Sangue 3 ; 10153 ; Turin ; Italy
  
• 关键词：Diaphragmatic hernia ; Surgical complication ; Mesh repair ; Laparoscopic repair
• 刊名：World Journal of Emergency Surgery
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：9
• 期：1
• 全文大小：762 KB
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• 刊物主题：Emergency Medicine; Traumatic Surgery;
• 出版者：BioMed Central
• ISSN：1749-7922

文摘

We describe the laparoscopic management of diaphragmatic hernia (DH) caused by vertebral pedicle screw displacement. A 58-year-old woman underwent surgery for scoliosis and underwent posterior pedicle screw fixation. In the first postoperative (PO)day, she developed mild dyspnea. An anteroposterior chest radiograph revealed bilateral pleural effusion, which was more pronounced on the left side. A thoracoabdominal computed tomography (CT) scan, performed in the second PO day, revealed a solid mass in the pleural cavity that was associated with screw displacement, which had also entered into the peritoneal cavity without apparent other lesion of hollow and solid viscous. In the third PO day, after the screw was removed, explorative laparoscopy was carried out. We observed herniation of the omentum through a small diaphragmatic tear. Once the absence of visceral injury was confirmed, we reduced the omentum into the abdomen. Then, we repaired the hernia by applying a dual layer polypropylene mesh over the defect with a 3-cm overlap. The remainder of the postoperative period was uneventful. Iatrogenic DH due to a pedicle screw displacement has never been described before. In cases of pleural effusion following spinal surgery, rapid assessment and treatment are crucial. We conclude that a laparoscopic approach to iatrogenic DH could be feasible and effective in a hemodynamically stable patient with negative CT findings because it enables the completion of the diagnostic cascade and the repair of the tear, providing excellent visualization of the abdominal viscera and diaphragmatic tears.