Skip to main content
SpringerLink
Log in

Incarcerated diaphragmatic hernia after right hepatectomy: an autopsy case with a review of 45 previous cases

  • Case Report
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

An iatrogenic diaphragmatic hernia after major hepatic resection is a rare complication. Incarceration of the abdominal organ through a diaphragmatic defect can have a fatal prognosis. Here, we report a case of incarcerated diaphragmatic hernia after right hepatectomy, which was diagnosed only after the autopsy. The deceased, who had right hepatectomy 1 year previously, complained of severe chest pain, and 4 days later was found dead. Localized decomposition in his chest and abdomen suggested a late complication of the surgery because the location was consistent with the prior surgical area. In the autopsy, there was a small defect in his right diaphragm, resulting in the herniation and incarceration of the small intestine. Gross and microscopic findings of the herniated small intestine were consistent with ischemic enteritis. Different from our case, most of the previously reported cases showed a good prognosis after surgical repair, except one lethal one. Even though its overall incidence is very low, an incarcerated diaphragmatic hernia is one of the critical complications of major hepatic resection. The clinicians should warn the patients to avoid preventable morbidity and mortality. Reviewing this fatal complication would be also helpful for forensic pathologists and death investigators.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Manzini G, Kuemmerli C, Reiner CS, Petrowsky H, Gutschow CA (2019) Enterothorax after hepatic surgery: a single-center experience. World J Surg 43(3):902–909. https://doi.org/10.1007/s00268-018-4838-9

    Article  CAS  PubMed  Google Scholar 

  2. Oh JW, Oh SN, Jung SE, Byun JY (2017) Diaphragmatic hernia after living-donor right hepatectomy: an important late donor complication. J Comput Assist Tomogr 41(5):726–730. https://doi.org/10.1097/RCT.0000000000000591

    Article  PubMed  Google Scholar 

  3. Esposito F, Lim C, Salloum C, Osseis M, Lahat E, Compagnon P, Azoulay D (2017) Diaphragmatic hernia following liver resection: case series and review of the literature. Ann Hepatobiliary Pancreat Surg 21(3):114–121. https://doi.org/10.14701/ahbps.2017.21.3.114

    Article  PubMed  PubMed Central  Google Scholar 

  4. Livingstone SM, Andres A, Shapiro AM, Kneteman NN, Bigam DL (2016) Diaphragmatic hernia after living donor right hepatectomy: proposal for a screening protocol. Transplant Direct 2(7):e84. https://doi.org/10.1097/TXD.0000000000000596

    Article  PubMed  PubMed Central  Google Scholar 

  5. Tabrizian P, Jibara G, Shrager B, Elsabbagh AM, Roayaie S, Schwartz ME (2012) Diaphragmatic hernia after hepatic resection: case series at a single Western institution. J Gastrointest Surg 16(10):1910–1914. https://doi.org/10.1007/s11605-012-1982-7

    Article  PubMed  Google Scholar 

  6. Vernadakis S, Paul A, Kykalos S, Fouzas I, Kaiser GM, Sotiropoulos GC (2012) Incarcerated diaphragmatic hernia after right hepatectomy for living donor liver transplantation: case report of an extremely rare late donor complication. Transplant Proc 44(9):2770–2772. https://doi.org/10.1016/j.transproceed.2012.09.014

    Article  CAS  PubMed  Google Scholar 

  7. Kousoulas L, Becker T, Richter N, Emmanouilidis N, Schrem H, Barg-Hock H, Klempnauer J, Lehner F (2011) Living donor liver transplantation: effect of the type of liver graft donation on donor mortality and morbidity. Transpl Int 24(3):251–258. https://doi.org/10.1111/j.1432-2277.2010.01183.x

    Article  PubMed  Google Scholar 

  8. Hemming AW, Reed AI, Langham MR, Fujita S, van der Werf WJ, Howard RJ (2002) Hepatic vein reconstruction for resection of hepatic tumors. Ann Surg 235(6):850–858. https://doi.org/10.1097/00000658-200206000-00013

    Article  PubMed  PubMed Central  Google Scholar 

  9. Reber PU, Schmied B, Seiler CA, Baer HU, Patel AG, Buchler MW (1998) Missed diaphragmatic injuries and their long-term sequelae. J Trauma 44(1):183–188. https://doi.org/10.1097/00005373-199801000-00026

    Article  CAS  PubMed  Google Scholar 

  10. Lu J, Wang B, Che X, Li X, Qiu G, He S, Fan L (2016) Delayed traumatic diaphragmatic hernia: a case-series report and literature review. Medicine (Baltimore) 95(32):e4362. https://doi.org/10.1097/MD.0000000000004362

    Article  Google Scholar 

  11. Testini M, Girardi A, Isernia RM, De Palma A, Catalano G, Pezzolla A, Gurrado A (2017) Emergency surgery due to diaphragmatic hernia: case series and review. World J Emerg Surg 12:23. https://doi.org/10.1186/s13017-017-0134-5

    Article  PubMed  PubMed Central  Google Scholar 

  12. Patrizi A, Jezequel C, Sulpice L, Meunier B, Rayar M, Boudjema K (2016) Disposable bipolar irrigated sealer (Aquamantys((R))) for liver resection: use with caution. Updates Surg 68(2):171–177. https://doi.org/10.1007/s13304-016-0367-y

    Article  PubMed  Google Scholar 

  13. Jeng KS, Huang CC, Lin CK, Lin CC, Wu JM, Chen KH, Chu SH (2015) Early incarcerated diaphragmatic hernia following right donor hepatectomy: a case report. Transplant Proc 47(3):815–816. https://doi.org/10.1016/j.transproceed.2015.02.001

    Article  PubMed  Google Scholar 

  14. Mizuno S, Tanemura A, Isaji S (2014) Incarcerated left diaphragmatic hernia following left hepatectomy for living donor liver transplantation. Transpl Int 27(7):e65-67. https://doi.org/10.1111/tri.12289

    Article  PubMed  Google Scholar 

  15. Dieter RA Jr, Spitz J, Kuzycz G (2011) Incarcerated diaphragmatic hernia with intrathoracic bowel obstruction after right liver donation. Int Surg 96(3):239–244. https://doi.org/10.9738/cc10.1

    Article  PubMed  Google Scholar 

  16. Komatsu T, Henteleff H (2010) Colopleural fistula with atypical presentation as a complication of diaphragmatic hernia repair. Ann Thorac Surg 90(2):662–663. https://doi.org/10.1016/j.athoracsur.2010.02.030

    Article  PubMed  Google Scholar 

  17. Perwaiz A, Mehta N, Mohanka R, Kumaran V, Nundy S, Soin AS (2010) Right-sided diaphragmatic hernia in an adult after living donor liver transplant: a rare cause of post-transplant recurrent abdominal pain. Hernia 14(5):547–549. https://doi.org/10.1007/s10029-009-0594-y

    Article  CAS  PubMed  Google Scholar 

  18. Schellhaas E, Dobler O, Kroesen AJ, Buhr HJ, Hotz HG (2010) Gangrenous intrathoracic appendicitis, a rare cause of right-sided chest pain: report of a case. Surg Today 40(9):874–877. https://doi.org/10.1007/s00595-009-4172-9

    Article  PubMed  Google Scholar 

  19. Matz D, Kirchhoff P, Kocher TM, Heizmann O (2009) Consecutive cecum perforation due to incarcerated diaphragmatic hernia after liver surgery. Int J Colorectal Dis 24(11):1353–1354. https://doi.org/10.1007/s00384-009-0706-2

    Article  PubMed  Google Scholar 

  20. Hawxby AM, Mason DP, Klein AS (2006) Diaphragmatic hernia after right donor and hepatectomy: a rare donor complication of partial hepatectomy for transplantation. Hepatobiliary Pancreat Dis Int 5(3):459–461

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Seoul National University Hospital, Seoul, South Korea

    Sang Won Lee

  2. Department of Forensic Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Sang Won Lee & Soong Deok Lee

  3. Institute of Forensic and Anthropological Science, Seoul National University College of Medicine, Seoul, South Korea

    Soong Deok Lee

  4. Department of Anatomy and Cell Biology, Sungkyunkwan University School of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea

    Moon-Young Kim

Authors
  1. Sang Won Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soong Deok Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moon-Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Moon-Young Kim.

Ethics declarations

Ethical approval

This study did not require ethical approval; however, the authors made the best effort to comply with the general principles of research ethics.

Informed consent

Informed consent was not available because any relatives of the deceased or other qualified individuals were not identified.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S.W., Lee, S.D. & Kim, MY. Incarcerated diaphragmatic hernia after right hepatectomy: an autopsy case with a review of 45 previous cases. Int J Legal Med 135, 1549–1554 (2021). https://doi.org/10.1007/s00414-021-02557-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-021-02557-4

Keywords

Search

Navigation