Unusual delayed presentation of post-traumatic intrapericardial hernia associated with intestinal occlusion

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COD: 01_2010_045-48 Categorie: ,

Alessandro Bini, Fabio Davoli, Nicola Cassanelli, Giampiero Dolci, Giulia Luciano, Franco Stella

Ann. Ital. Chir., 2010; 81: 45-47

 

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AIM: We report a case of a 64-year-old man, admitted to our department following the onset a few months earlier of
canalization disorders and a sensation of retrosternal tension.
MATERIAL OF STUDY: Patient’s history revealed blunt thoraco-abdominal trauma with multiple costal fractures 15 years
earlier as a result of a road accident and a cholecystectomy at the age of 57. A barium meal revealed an intrapericardial
displacement of some intestinal loops; as the patient suffered acute intestinal occlusion with severe abdominal pain
associated with nausea and vomiting, we performed an emergency median xipho-umbilical laparotomy, making it possible
to identify both the site of the retrosternal diaphragmatic laceration with intrapericardial colonic herniation and the
true cause of the occlusion: an adhesion, caused by the previous cholecistectomy, which was strangulating a jejunal loop.
After detaching the adhesion between the colon and the pericardium, the viscera were replaced in the abdominal cavity
and the diaphragmatic opening was closed.
RESULTS: The post-operative period was uneventful; a barium enema demonstrated the abdominal dislocation of the viscera.
No recurrence was detected during the 48 months of follow-up.
CONCLUSIONS: A rare pathological event, such as an intrapericardial diaphragmatic hernia, was combined with intestinal
occlusion, initially attributed to a further complication of the hernia itself, but in actual fact independent of the
hernia and a consequence of a previous cholecystectomy.

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