Left diaphragmatic hernia due to muscle rupture after hypopressive abdominal gymnastics

A 46-year-old male patient came to the emergency room for sudden, intense abdominal pain that initially started in the left flank and later became diffuse, accompanied by vomiting. He reported the onset of symptoms after performing hypopressive abdominal gymnastics. In the emergency department, he was in good general condition with slight tachypnea and an abdomen that showed no signs of peritoneal irritation.

Imaging studies (Figs. 1 and 2) identified rupture of the left diaphragm, resulting in a large hernia containing the stomach, body-tail of the pancreas and the spleen.

Fig. 1

Fig. 2

Urgent laparoscopy was indicated. The hernia content was reduced, and primary closure of the diaphragmatic rupture was performed with nonabsorbable suture.

Figs. 1 and 2: marked with arrows from top to bottom: stomach, spleen, pancreas and diaphragm.