PMC3015605_01
Initial chest x-ray showed air fluid level in left thoracic cavity.
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The initial chest radiograph on admission showed a large air-fluid level in the left thoracic cavity (Figure 1).
Oral contrast and follow through study showed herniation of abdominal contents into left thoracic cavity with no mechanical obstruction.
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F2
No evidence was present of mechanical gastrointestinal obstruction (Figure 2).
Laparoscopic view showed herniation of spleen, stomach, part of small bowel and splenic flexure of colon through the diaphragmatic defect.
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Nearly all of the stomach, the entire spleen, part of the small bowel, the splenic flexure of the colon and its omentum had herniated though this defect (Figure 3).
Laparoscopic view showed the diaphragmatic defect repaired and buttressed with Gore-Tex DualMesh secured by helical staples
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Associates, Inc, USA), which was secured with Tacker Helical Fasteners (Tyco Health Care, Ltd, USA) (Figure 4). A chest drain was inserted to the left thoracic cavity at the end of the procedure.