A case of delayed diaphragmatic hernia presenting with intestinal strangulation following thoracic surgery

We have recently encountered a very rare case of delayed diaphragmatic hernia presenting with intestinal strangulation following thoracic surgery. A 61-year-old female began to experience cough and back pain fifteen months after resection of the left lower pulmonary lobe due to aspergillosis. Thereafter the symptom became aggravated over time. During the previous operative procedure, wide dissection between the pulmonary lobe and diaphragm was performed because of severe adhesion. Subsequently she was admitted to our hospital on October 5, 2001 complaining of severe stomach and back pain. Chest X-ray on admission showed an abnormal shadow in the left lower lung field. Successive chest computed tomography finally demonstrated that the gastrointestinal tract was escaped into the left thoracic cavity. Surgery was immediately performed under a diagnosis of strangulated diaphragmatic hernia. At surgery, the stomach and omentum had projected into the left thoracic cavity through a laceration about 3 cm in diameter in the diaphragm. We successfully repaired the laceration of the diaphragm directly using an interrupted suture. The postoperative course was uneventful, and the patient was discharged on the 14th postoperative day and is doing well. We should consider the possibility of delayed presentation of diaphragmatic hernia following thoracic surgery during which an invasive technique involving the diaphragm was undertaken.