Incarcerated intrapericardial diaphragmatic hernia after laparoscopic pericardial window for malignant pericardial effusion

Laparoscopic Pericardial Window (LPW) is a safe, minimally invasive surgical technique for treating pericardial effusion/tamponade. This technique allows adequate decompression and avoids single-lung ventilation and the need for thoracic drainage in severely ill patients; it also provides anatomopathological and microbiological diagnosis leading to treatment measures. An intrapericardial diaphragmatic hernia is among the rarest complications of this procedure. A 85-year-old man, who underwent LPW for pericardial tamponade, presented to the emergency department 12 days post-operative with bowel obstruction; CT scan showed an incarcerated hernia into the pericardial sac. Laparoscopic reduction and hernia repair were performed using a large-pore Mesh to allow further drainage of histologically proven malignant pericardial effusion. Keywords: pericardial tamponade; pericardial window; surgical drainage of pericardial effusion; intra-pericardial diaphragmatic hernia.

Intra pericardial herniation in congenital diaphragmatic hernia

Intrapericardial diaphragmatic hernia is a rare condition with only few cases reported in the English language literature.1 During a span of eight months in 2010-2011 we treated two cases of congenital intra pericardial diaphragmatic hernia in Royal Hospital in the Sultanate of Oman. The first case was not diagnosed antenatally as diaphragmatic hernia. Post-natally the neonate was diagnosed as having pericardial effusion and correct diagnosis arrived at by CTs can. The second case was diagnosed by antenatal scan as diaphragmatic hernia and confirmed in postnatal period by chest X-Ray as left congenital diaphragmatic hernia but intra-operative finding was an anterior diaphragmatic hernia with intra pericardial herniation of the liver and part of the bowel into the pericardial sac. Both neonates were intubated after birth due to respiratory distress. A polytetrafluoroethylene (PTFE) patch was used for repair of the defect in first case and the second case was repaired without a patch. In both cases, apart from the defect, the rest of the diaphragm, on either side, was intact; sac was absent and a pericardial defect was present. Both neonates were discharged in good condition.

Asymptomatic congenital intrapericardial diaphragmatic hernia in a woman becoming symptomatic after childbirth

This paper describes a rare case presentation of congenital asymptomatic intrapericardial diaphragmatic hernia. In this case, the female patient survived without symptoms for over 30 years until becoming symptomatic at childbirth. Diaphragmatic hernia occurs when abdominal viscera protrude into the thoracic cavity, with pericardial hernias being the rarest type. Diaphragmatic hernia can be caused by trauma that raises the intra-abdominal pressure, whereas congenital hernias are often symptomatic at birth. It is rare to have a congenital asymptomatic intrapericardial diaphragmatic hernia, where the patient survives until adulthood and subsequently becomes symptomatic after delivering a child; hence, that is the uniqueness of this case.