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. 2016:28:266-269.
doi: 10.1016/j.ijscr.2016.10.015. Epub 2016 Oct 11.

Dual mesh repair for a large diaphragmatic hernia defect: An unusual case report

Metin Ercan  1 , Mehmet Aziret  2 , Kerem Karaman  1 , Birol Bostancı  1 , Musa Akoğlu  1
Affiliations

Dual mesh repair for a large diaphragmatic hernia defect: An unusual case report

Metin Ercan et al. Int J Surg Case Rep. 2016.

Abstract

Introduction: Diaphragmatic hernia secondary to traumatic rupture is a rare entity which can occur after stab wound injuries or blunt abdominal traumas. We aimed to report successfully management of dual mesh repair for a large diaphragmatic defect.

Case report: A 66-year-old male was admitted with a right sided diaphragmatic hernia which occurred ten years ago due to a traffic accident. He had abdominal pain with worsened breath. Chest X-ray showed an elevated right diaphragm. Further, thoraco-abdominal computerized tomography detected herniation a part of the liver, gallbladder, stomach, and omentum to the right hemi-thorax. It was decided to diaphragmatic hernia repair. After an extended right subcostal laparotomy, a giant right sided diaphragmatic defect measuring 25×15cm was found in which the liver, gallbladder, stomach and omentum were herniated. The abdominal organs were reducted to their normal anatomic position and a dual mesh graft was laid to close the diaphragmatic defect. Patients' postoperative course was uneventful.

Discussion: Diaphragmatic hernia secondary to trauma is more common on the left side of the diaphragm (left/right=3/1). A right sided diaphragmatic hernia including liver, stomach, gallbladder and omentum is extremely rare. The main treatment of diaphragmatic hernias is primary repair after reduction of the herniated organs to their anatomical position. However, in the existence of a large hernia defect where primary repair is not possible, a dual mesh should be considered.

Conclusion: A dual mesh repair can be used successfully in extensive large diaphragmatic hernia defects when primary closure could not be achieved.

Keywords: Diaphragm hernia; Dual mesh; Traumatic diaphragm rupture.

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Figures

Fig. 1
Fig. 1
Chest X Ray showing an elevated right diaphragm.
Fig. 2
Fig. 2
Herniation of the liver, gallbladder, omentum and stomach in thoracic CT.
Fig. 3
Fig. 3
Intraoperatively reduction of herniated organs.
Fig. 4
Fig. 4
Reduction of herniated organs.
Fig. 5
Fig. 5
Appearance of giant diaphragmatic defect.
Fig. 6
Fig. 6
Repairing of diaphragmatic defect with dual mesh.
Fig. 7
Fig. 7
Appearance of postoperative right diaphragm in chest X-ray.
Fig. 8
Fig. 8
Chest X-ray after postoperative 3 months.
See this image and copyright information in PMC

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