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Diaphragmatic hernias are a migration of abdominal structures into the thorax via a diaphragmatic defect; they may
be classified as congenital or acquired and acquired hernias can be hiatal, traumatic or iatrogenic, generally complications
of thoracic or abdominal surgery. We report a case of iatrogenic diaphragmatic hernia after a laparoscopic left colectomy
for splenic flexure tumor; to our knowledge, in literature this case is the first reported. A 51-years-old woman was
readmitted to our Hospital on 11th post-operative day for bowel occlusion and a CT – scan revealed left diaphragmatic
herniation with fluid dilatation of the small bowel that appeared in the left hemithorax. Laparoscopic surgery resolution
was decided and after the reduction of the small bowel in the abdomen we closed the defect using two direct absorbable
auto-block hemi-continuous sutures that were covered by a synthetic absorbable mesh. Probably we didn‘t notice a minimal
injury of the left diaphragm caused by ultrasonic scalpel and we can suppose that this delay in presentation may
be a result of the gradual enlargement of a microscopic lesion. Patient’s gas exchanges were good during surgery and during
post-operative course.
