ABSTRACT TITLE: VERY UNUSUAL VARIANT OF DIAPHRAGMATIC HERNIA OR

A RARE VARIANT OF DIAPHRAGMATIC HERNIA THROUGH CENTRAL TENDON

AUTHOR: DR. OM TANTIA ADDRESS: Dr. Om Tantia Medical Director & Head Department of Minimal Access & Bariatric Surgery ILS Hospitals, DD-6, Salt Lake City, Sector - 1 Kolkata - 700064 India. E-mail: omtantia@gmail.com Ph: +919830400444

INTRODUCTION: Diaphragmatic hernia through central tendon after CABG is a very rare entity. Diaphragmatic hernia after CABG has been reported but those were the cases in which gastoepiploic artery was used as a graft. We did a laparoscopic repair of a diaphragmatic hernia through central tendon in a patient who had CABG done almost 17 years back.

METHOD: A 65 year old patient developed acute intestinal obstruction with strangulation secondary to herniation of small intestine through a small defect in the central tendon of the diaphragm as diagnosed on CT-scan of abdomen. The patient never had any trauma to his chest or abdomen and had no history suggestive of congenital nature of the diaphragmatic hernia. However he had coronary artery bypass grafting with saphenous vein used as a graft; done almost 17 years back hence we suspect it to be an iatrogenic hernia. A laparoscopic herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. RESULT: Post-operatively patient was asymptomatic and was discharged on 4th post-operative day CONCLUSION: Iatrogenic diaphragmatic hernias are very rare entity. Iatrogenic diaphragmatic hernia have been reported after CABG when gastroepiploic artery was used as a graft. Post CABG diaphragmatic hernia with saphenous venous graft has not been reported in past. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. CT- scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients