AB161. SOH21AS140. Spontaneous diaphragmatic hernias: The Twisted Tango
General Poster Session

AB161. SOH21AS140. Spontaneous diaphragmatic hernias: The Twisted Tango

Hugo Temperley1,2, Caitlin Waters1,2, Laura Staunton1,2, Michael MacLean1,2, Noel Donlon1,2, Narayanasamy Ravi1,2, John Reynolds1,2, Claire Donohue1,2

1Department of Surgery, St. James’s Hospital, Dublin, Ireland; 2Trinity Centre for Health Sciences, St. James’s Hospital and Trinity College, Dublin, Ireland

Background: Spontaneous diaphragmatic hernias are a rare surgical emergency, encompassing 1% of diaphragmatic injuries. The most common aetiology is that of a sudden increase in intra-abdominal pressure, such as post vomiting, coughing, defaecation, physical exercise, and vaginal delivery. There were no such precipitating factors in the following case.

Methods: Here we discuss the case of a 46-year-old female who presented to her local Emergency Department with a one-day history of epigastric pain radiating to the left scapular region and neck, which was associated with nausea and vomiting. She had no preceding trauma, with no clear aetiology identified. She was haemodynamically stable with an isolated tachycardia. Abdominal examination revealed marked guarding and rebound tenderness epigastrically. Computed tomography (CT) Abdomen Pelvis demonstrated the stomach herniating through a narrow-necked defect of the left hemidiaphragm with no definitive evidence of strangulation. She was subsequently transferred to our institution and underwent emergency laparoscopic converted to open exploration, reduction of the stomach and repair of the defect. Intra-operatively a necrotic wedge of the greater curve was identified and resected, with its attached omentum. The diaphragmatic defect was closed with interrupted sutures.

Results: The patient was admitted to intensive care unit (ICU) for close observation and was commenced on total parenteral nutrition (TPN) in the immediate post-operative period with broad spectrum antimicrobial cover. Her post-operative recovery was uneventful.

Conclusions: Diaphragmatic hernias are rare in the absence of trauma, with early recognition and definitive surgical management being imperative to achieve favourable post-operative outcomes.

Keywords: Diaphragm; hernia; rupture; spontaneous; strangulation


Funding: None.


Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-21-ab161
Cite this abstract as: Temperley H, Waters C, Staunton L, MacLean M, Donlon N, Ravi N, Reynolds J, Donohue C. SOH21AS140. Spontaneous diaphragmatic hernias: The Twisted Tango. Mesentery Peritoneum 2021;5:AB161.

Download Citation