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Rare complication after pericardial window: symptomatic diaphragmatic hernia containing bowel and liver
  1. Rebecca Harsten1,
  2. Mark Kelly2,
  3. Madeleine Garner2 and
  4. Peter Roberts1
  1. 1Critical Care, Queen Elizabeth Woolwich, London, UK
  2. 2General Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Rebecca Harsten; rebecca.harsten{at}nhs.net

Abstract

A 37-year-old woman presented to her local district general hospital with a cough, pleuritic chest pain and intermittent cyanosis. Eight months prior, she underwent a successful pericardial window for recurrent, symptomatic pericardial effusions. On presentation she was hypoxic but haemodynamically stable. Her chest radiograph raised the suspicion of a diaphragmatic hernia, confirmed by CT imaging. This identified herniation through the diaphragm of the transverse colon and left lobe of the liver resulting in cardiac compression and right ventricular dysfunction. She continued to deteriorate and required emergency intubation to allow safe transfer to a tertiary upper gastrointestinal unit. She underwent a laparotomy and repair of the diaphragmatic hernia with an uneventful inpatient recovery. In the literature, diaphragmatic liver herniation is a recognised complication secondary to trauma or congenital defects, however, to our knowledge, there are currently no cases described following pericardial windowing.

  • pericardial disease
  • adult intensive care
  • gastrointestinal surgery
  • cardiothoracic surgery
  • mechanical ventilation

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Footnotes

  • Contributors RH cared for the patient during admission, gained consent and has written the case report draft. MK was the surgical consultant who operated on the patient and has provided valuable intraoperative information, and edited the revised manuscript. MG has helped gather imaging, documentation and investigations from the tertiary centre, as well as helped with technical editing of the manuscript and helped get better resolution of the images. PR was the intensive care consultant who was medically responsible for the patient in the DGH. PR has additionally proofread, corrected and advised on appropriate academic terminology of the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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