Diaphragmatic hernias requiring emergency surgery: a retrospective analysis

Aim: Diaphragmatic hernias can originate from the esophageal hiatus, congenital defects, or traumatic defects of the diaphragm caused by penetrating or blunt trauma of the thoracoabdominal region.This retrospective analysis aims to examine cases of diaphragmatic hernia that were operated on as surgical emergencies in our hospital.Methods: Medical records of all the patients who underwent diaphragmatic hernia repair in the General Surgery Clinic of Istanbul Training and Research Hospital between 2005 and 2019 were examined.Cases operated under emergency conditions were selected for detailed analysis.Results: Cases requiring urgent intervention constituted 25% of all diaphragmatic hernia repairs.The mean age of the patients was 54.1 (18-93) years.Ten patients (52.6%) were male and 9 (47.4%) were female; 1 patient was a male infant.Among hernias requiring emergency intervention, 8 patients (42.1%) were operated on because of obstructive symptoms, while 6 (31.6%) others were operated on because of signs of strangulation.Organ perforation was present in 4 patients (21.1%).One patient (5.3%) was operated on for severe respiratory distress.One male infant was operated on for sliding hernia of the stomach into the mediastinum and causing respiratory distress.The mean hospital stay was 14.7 days in the adult group, while the duration of hospitalization of the infant was 21 days.In the postoperative period, wound dehiscence in 2 patients, subcutaneous hemorrhage in 2 patients, and ileoileal intussusception in an infant patient developed.One patient was re-hospitalized for respiratory distress after discharge.The patient failed to respond to treatment and died on postoperative day 21.Conclusion: Diaphragmatic hernias in all ages can be true surgical emergencies that require immediate action, especially in the presence of respiratory distress, strangulation, and perforation.