PMC7229409_01
A-B. Pre-operative thoracoabdominal computed tomography scan: the seven-centimeter left hemi-diaphragmatic defect associated with herniation of the fundus, body and gastric antrum, along with the spleen.
gr1.jpg
PMC7229409_01_gr1.jpg
fig0005
Given the findings, an abdominal CT-scan was performed identifying a seven centimeter left hemi-diaphragmatic defect associated with herniation of the fundus, body and gastric antrum, along with the spleen (Fig. 1A and B).
A-F. Intra-operative images: the left diaphragmatic hernial defect of seven by five centimeters with protrusion of half the stomach, omentum and the posterior aspect of the spleen with sub capsular tear, with preservation of the hiatus [A:C]. Once the Thoracic Surgery group had performed extensive adhesiolysis and decortication, the extraction of the protruding sac without damaging the spleen was attained, enabling a primary repair without tension [D:F].
gr2.jpg
PMC7229409_01_gr2.jpg
fig0010
The reduction of the herniated organs was achieved through abdominal laparoscopy, however a complete dissection was not possible due to the splenic interposition (Fig. 2A-C). The Thoracic Surgery group, through a thoracoscopic approach, performed extensive adhesiolysis and decortication, achieving the extraction of the protruding sac without damaging the spleen thus enabling a primary repair without tension (Fig. 2D-F).
A-B. Post-operative thoracoabdominal computed tomography scan: a satisfactory correction of the diaphragmatic hernia.
gr3.jpg
PMC7229409_01_gr3.jpg
fig0015
Six months later he was reviewed with an abdominal CT-scan showing a satisfactory diaphragmatic hernial correction (Fig. 3A-B).