Incarcerated Small-Bowel Pericardial Diaphragmatic Hernia After Pericardio-Peritoneal Window Creation: Report of a Rare Case
BACKGROUND Pericardio-peritoneal windows are surgically created to treat symptomatic pericardial effusion, usually of oncological origin, to alleviate cardiac tamponade-like symptoms. Common complications include infection, failure to drain the fluid correctly, and arrythmias. There are few publishe...
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Published in | The American journal of case reports Vol. 22; p. e930441 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
United States
International Scientific Literature, Inc
14.04.2021
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Subjects | |
Online Access | Get full text |
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Summary: | BACKGROUND Pericardio-peritoneal windows are surgically created to treat symptomatic pericardial effusion, usually of oncological origin, to alleviate cardiac tamponade-like symptoms. Common complications include infection, failure to drain the fluid correctly, and arrythmias. There are few published cases of intra-abdominal complications due to these interventions. This report discusses pericardial diaphragmatic incarcerated hernia, which is one such complication. CASE REPORT We report the case of an 84-year-old woman with advanced non-small cell lung carcinoma, who recently underwent surgery to create a pericardio-peritoneal window to treat a chronic malignant pericardial effusion. The patient presented in our Emergency Department because of abdominal pain with absence of flatus and stool for more than 4 days. Computed tomography scanning confirmed a proximal small-bowel obstruction due to incarcerated small bowel into the pericardial window. Reduction of the hernia was performed laparoscopically. After a bowel viability assessment by indocyanine green angiography, the pericardial window was covered by a noncovered macroporous mesh to avoid recurrence and to allow continuous pericardial fluid drainage. CONCLUSIONS In case of abdominal pain after the creation of a pericardio-peritoneal window, we suggest the prompt use of computed tomography after initial examination. Indeed, although rare, a pericardial diaphragmatic hernia is possible and requires surgical exploration if there is a risk of bowel strangulation. The operation can be done laparoscopically, and the hernia repair should involve the placement of a nonabsorbable and noncovered macroporous mesh. This should prevent hernia recurrence, while also allowing adequate drainage of the pericardial effusion. |
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Bibliography: | ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 Funds Collection Authors’ Contribution Conflict of interest: None declared Data Interpretation Literature Search Data Collection Study Design Manuscript Preparation Statistical Analysis |
ISSN: | 1941-5923 1941-5923 |
DOI: | 10.12659/ajcr.930441 |