CTICasesIatrogenic Left Hemidiaphragm Injury with Gastrothorax
Imaging findings
Post-operative chest radiograph following left adrenal ganglioneuroma resection shows a new air-fluid level in the left thorax with distended stomach visible above the diaphragm. CT confirms a large left hemidiaphragm defect with herniation of a markedly distended and angulated stomach into the left thoracic cavity, along with evidence of splenic injury.
Key takeaways
Inadvertent diaphragmatic laceration during retroperitoneal/abdominal surgery is an uncommon but serious complication. Prompt recognition on post-operative chest radiography is critical, as stomach herniation with angulation can cause gastric ischemia and perforation. Repair requires reduction of the herniated viscera, partial gastrectomy if ischemic, and primary diaphragm closure.
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