Delayed Strangulated Right Diaphragmatic Hernia after Retroperitoneal Tumor Resection with Hepatectomy: A Case Report.

Abstract

<h4>Introduction</h4>Delayed iatrogenic diaphragmatic hernia after abdominal surgery is an uncommon complication; however, cases occurring after hepatectomy are relatively more commonly reported in the literature. Such hernias often develop after a significant latency period, but may progress to life-threatening emergencies, including bowel strangulation. Here, we report a rare case of delayed right diaphragmatic hernia following hepatectomy.<h4>Case presentation</h4>A man in his 70s, with a history of right hepatectomy for retroperitoneal liposarcoma 4 years prior, presented with acute abdominal pain. CT revealed a strangulated right diaphragmatic hernia with intestinal ischemia. The hernia orifice, which had enlarged by approximately 10 mm/year compared with prior imaging over the preceding 2 years, measured 55 mm on CT but was found to be an 80-mm defect intraoperatively. Emergency surgery confirmed extensive bowel necrosis, requiring large intestinal resection and primary repair. The patient developed short bowel syndrome and was discharged on POD 24.<h4>Conclusions</h4>Post-hepatectomy diaphragmatic hernias may enlarge and be underestimated on imaging. Early surgery and close follow-up are recommended in such cases, as delayed intervention can result in life-threatening complications.