Right diaphragmatic hernia after major hepatectomy

Male, 75 years old, personal history: cirrhosis of the liver, active smoker. Right hepatectomy in 2020 (poorly differentiated giant hepatocarcinoma).

Admitted to Traumatology after excision of a single metastasis of hepatocarcinoma in the left lumbar paravertebral musculature. On the second postoperative day he began vomiting and abdominal pain. Urgent abdominal CT scan showed continuity defect in the middle third of the right hemidiaphragm, herniation of small bowel loops, right colon, and part of the pancreas, causing segmental atelectasis of the right lower lobe. No free fluid or signs of bowel distress (Figs. 1 and 2). After assessing the patient, physical examination unremarkable, LDH 12, leucocytes 10500, we decided conservative management with favourable outcome.

Fig. 1

Fig. 2

Discharge pending surgery: repair of diaphragmatic defect.