A fatal complication of an incarcerated diaphragmatic hernia: pyo-pneumopericardium due to a gastro-pericardial fistula Case report and literature review

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COD: 01_2016_1183_2439 Categorie: ,

Bogdan Andrei Suciu, Mihaela Opris, Vasile Bud, Constantin Copotoiu, Klara Brînzaniuc, Mircea Mures

Ann. Ital. Chir., 2016 87: 75-78

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INTRODUCTION: The pyo-pneumopericardium is a very rare complication of an incarcerated diaphragmatic hernia. Usually,
it depends on the existence of a gastropericardial fistula and, in most cases, it is a deadly complication.
CASE REPORT: We present the case of a 65 year old man who was admitted to our emergency service with clinical signs
of septic shock. With the help of the CT scan a pyo-pneumopericardium and incarcerated diaphragmatic hernia was
diagnosed. He was subjected to emergency surgical intervention with double approach (thoracic and abdominal), discerning
during surgery the existence of a pericardial abscess due to a gastro-pericardial fistula due to an incarcerated
diaphragmatic hernia. The gastric fundus was resected with abolition of the gastro-pericardial fistula, evacuation of the
pericardial abscess, performing the splenectomy (in order to have a better surgical access) and adequate treatment of the
diaphragmatic hernia. Despite the medical efforts, the patient died on the 10th postoperative day due to septic complications.
To our knowledge this is the first case reported in the literature of gastro-pericardial fistula complicated with
pyo-pneumo-pericardium due to an incarcerated diaphragmatic hernia. In such cases we consider that only by performing
a double surgical approach (thoracic and abdominal) we can provide a proper resolution of the case, also based on
the objective situation found during surgery, where the splenectomy can provide an easier approach to the diaphragmatic
hernia.