Caso clínico 1: hernia diafragmática postraumática, Caso clínico 2: hernioplastia insicional lumbar

Abstract

Introduction: Diaphragmatic hernias are defined as the passage of abdominal organs into the thoracic cavity through a defect in the diaphragm, sometimes resulting from severe trauma, constituting a surgical challenge. Thoracoabdominal incisions are commonly used for various thoracic and vascular cases, although they are rarely used for diaphragmatic hernias, which are usually repaired by laparotomy, thoracotomy or minimally invasive approaches. Case report: We present the clinical case of a 25-year-old patient with a history of penetrating stab wound trauma 4 years ago, who came to the emergency room with diffuse abdominal pain diagnosed on admission as acute partial subocclusive abdomen treated surgically by exploratory laparotomy with surgical findings of non-diseased appendix and ileus, with torpid evolution 5 days later he presented respiratory difficulty, chest x-ray was performed showing left pleural effusion, treated with pleural drainage obtaining fecaloid liquid of approximately 1500ml volume, so it was decided to perform an urgent thoracotomy finding perforated diaphragmatic hernia + pleural empyema + necrosis of the splenic angle of the colon, diaphragmatic herniorraphy + pleural cavity lavage + decortication + pleural drainage + laparotomy + resection of the splenic angle of the colon + end-to-end anastomosis + peritoneal peritoneal cavity lavage + peritoneal cavity lavage + pleural drainage + peritoneal anastomosis + peritoneal anastomosis terminal anastomosis + peritoneal cavity lavage + Jackson Pratt drain placement Results: Patient remained hospitalized for 43 days, presented as a complication pachyepleuritis left empyema reintervened by left lateral thoracotomy, evolving favorably after receiving treatment with intravenous is discharged home in good condition. Introduction: Lumbar hernia is the rarest of all abdominal wall hernias and represents only 0.2% of all hernias. About 20% are congenital, mainly secondary to embryonic development defects, while 80% are acquired.1,2 The most recent literature recommends the laparotomy approach with the use of prosthetic materials as the most appropriate, so the procedure is fast, easy, and safe.2,3 Clinical case: A 46-year-old patient with a history of left radical nephrectomy by lumbotomy approach in 2021, who presents moderate intensity pain and sensation of mass protrusion in the left lumbar region. The physical examination showed a wall defect of approximately 10 cm diameter throughout abdominal content protruded at repose and before Valsalva maneuvers, but it was also reducible by external compression. Simple and contrast-enhanced computerized axial tomography (CAT) of the abdomen and pelvis reported a hernial defect at the left lumbar level with omental content of approximately 8x7cm without compromise of vascularization. A lumbar insicional hernioplasty was performed with a double mesh technique, “sandwich” type, one of them placed intraperitoneal and the second retromuscular. Conclusion: Surgical repair by open approach of hernial defects at the lateral level, using double mesh (intraperitoneal and inframuscular) “sandwich” type, is a safe technique and with satisfactory results in those patients with a defect greater than 5 cm with a bad quality aponeurosis.