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• W2096052712 abstract "A 66-year-old man was referred to our hospital after a traffic accident. On admission, he complained of thoracic and pelvic pain and was in a hemodynamically stable condition. Physical examination revealed subcutaneous emphysema on the left side of the thorax and abdominal tenderness. Chest roentgenogram showed fractured ribs (second to seventh) on the left side and an air bubble over the cardiac silhouette (Fig 1, arrows). Spiral computed tomographic scan demonstrated pelvic and costal fractures, left apical pneumothorax, pulmonary contusion, and posterior displacement of the heart by an intrapericardial air-filled mass (Fig 2, arrows). Pneumothorax was evacuated, and the patient was operated on through an upper midline laparotomy. The stomach was found to be herniated into the pericardial cavity. The hernia was reduced, and the diaphragmatic tear was repaired. The postoperative course was uneventful.Fig 2View Large Image Figure ViewerDownload (PPT)Intrapericardial diaphragmatic hernia is a very rare entity. Since the first reported case by DeCardinal in 1903 [1De Cardinal, Grenier, Bourderov Hernie diaphragmatique du colon transverse dans le pericarde chez un adulte. J Med Bordeaux 1903;23:22Google Scholar], less than 90 cases have been described worldwide [2Reina A. Vidaña E. Soriano P. et al.Traumatic intrapericardial diaphragmatic hernia case report and literature review.Injury. 2001; 32: 153-156Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar]. Although most of them were caused by blunt trauma sustained in a vehicular crash, use of the right gastroepiploic artery for coronary artery bypass grafting has recently emerged as an important cause of iatrogenic intrathoracic herniation of abdominal contents [3Manetta F. Moores D.W.O. Bennett E.V. Edwards N.M. Intrapericardial herniation of the stomach after the use of the right gastroepiploic artery for coronary artery bypass grafting.J Thorac Cardiovasc Surg. 1998; 115: 479-480Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar]. The stomach is the viscera most frequently involved (40%) after the transverse colon. Early diagnosis is achieved in only 48% of cases. Clinical symptoms vary from nonspecific abdominal or respiratory signs to cardiac tamponade, but asymptomatic cases are not rare. Surgical correction is mandatory in the prevention of gastric and cardiac complications. An upper midline laparotomy is the preferred approach; sternotomy should be reserved for cases of delayed diagnosis in which division of adhesions between the stomach and the pericardium is necessary. A 66-year-old man was referred to our hospital after a traffic accident. On admission, he complained of thoracic and pelvic pain and was in a hemodynamically stable condition. Physical examination revealed subcutaneous emphysema on the left side of the thorax and abdominal tenderness. Chest roentgenogram showed fractured ribs (second to seventh) on the left side and an air bubble over the cardiac silhouette (Fig 1, arrows). Spiral computed tomographic scan demonstrated pelvic and costal fractures, left apical pneumothorax, pulmonary contusion, and posterior displacement of the heart by an intrapericardial air-filled mass (Fig 2, arrows). Pneumothorax was evacuated, and the patient was operated on through an upper midline laparotomy. The stomach was found to be herniated into the pericardial cavity. The hernia was reduced, and the diaphragmatic tear was repaired. The postoperative course was uneventful. Intrapericardial diaphragmatic hernia is a very rare entity. Since the first reported case by DeCardinal in 1903 [1De Cardinal, Grenier, Bourderov Hernie diaphragmatique du colon transverse dans le pericarde chez un adulte. J Med Bordeaux 1903;23:22Google Scholar], less than 90 cases have been described worldwide [2Reina A. Vidaña E. Soriano P. et al.Traumatic intrapericardial diaphragmatic hernia case report and literature review.Injury. 2001; 32: 153-156Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar]. Although most of them were caused by blunt trauma sustained in a vehicular crash, use of the right gastroepiploic artery for coronary artery bypass grafting has recently emerged as an important cause of iatrogenic intrathoracic herniation of abdominal contents [3Manetta F. Moores D.W.O. Bennett E.V. Edwards N.M. Intrapericardial herniation of the stomach after the use of the right gastroepiploic artery for coronary artery bypass grafting.J Thorac Cardiovasc Surg. 1998; 115: 479-480Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar]. The stomach is the viscera most frequently involved (40%) after the transverse colon. Early diagnosis is achieved in only 48% of cases. Clinical symptoms vary from nonspecific abdominal or respiratory signs to cardiac tamponade, but asymptomatic cases are not rare. Surgical correction is mandatory in the prevention of gastric and cardiac complications. An upper midline laparotomy is the preferred approach; sternotomy should be reserved for cases of delayed diagnosis in which division of adhesions between the stomach and the pericardium is necessary." @default.
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• W2096052712 title "Traumatic intrapericardial herniation of the stomach" @default.
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• W2096052712 doi "https://doi.org/10.1016/s0003-4975(02)04999-8" @default.
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