Department of Surgery, SG Bosco Hospital, Piazza del donatore di Sangue 3, 10153 Turin, Italy.
Department of Neurosurgery, SG Bosco Hospital, Piazza delm donatore del Sangue 3, 10153 Turin, Italy.
World J Emerg Surg. 2014 Apr 29;9:34. doi: 10.1186/1749-7922-9-34. eCollection 2014.
We describe the laparoscopic management of diaphragmatic hernia (DH) caused by vertebral pedicle screw displacement. A 58-year-old woman underwent surgery for scoliosis and underwent posterior pedicle screw fixation. In the first postoperative (PO)day, she developed mild dyspnea. An anteroposterior chest radiograph revealed bilateral pleural effusion, which was more pronounced on the left side. A thoracoabdominal computed tomography (CT) scan, performed in the second PO day, revealed a solid mass in the pleural cavity that was associated with screw displacement, which had also entered into the peritoneal cavity without apparent other lesion of hollow and solid viscous. In the third PO day, after the screw was removed, explorative laparoscopy was carried out. We observed herniation of the omentum through a small diaphragmatic tear. Once the absence of visceral injury was confirmed, we reduced the omentum into the abdomen. Then, we repaired the hernia by applying a dual layer polypropylene mesh over the defect with a 3-cm overlap. The remainder of the postoperative period was uneventful. Iatrogenic DH due to a pedicle screw displacement has never been described before. In cases of pleural effusion following spinal surgery, rapid assessment and treatment are crucial. We conclude that a laparoscopic approach to iatrogenic DH could be feasible and effective in a hemodynamically stable patient with negative CT findings because it enables the completion of the diagnostic cascade and the repair of the tear, providing excellent visualization of the abdominal viscera and diaphragmatic tears.
我们描述了由椎弓根螺钉移位引起的膈疝 (DH) 的腹腔镜治疗。一位 58 岁女性因脊柱侧凸接受手术并接受了后路椎弓根螺钉固定。在术后第 1 天（PO），她出现轻度呼吸困难。前后位胸部 X 线片显示双侧胸腔积液，左侧更为明显。在术后第 2 天进行的胸腹部 CT 扫描显示胸腔内有实性肿块，与螺钉移位有关，螺钉也进入了腹腔，没有明显的其他空腔和实体粘性损伤。在术后第 3 天，取出螺钉后，进行了探查性腹腔镜检查。我们观察到网膜通过小的膈肌撕裂疝出。一旦确认没有内脏损伤，我们将网膜还纳入腹部。然后，我们通过在缺损处应用 3cm 重叠的双层聚丙烯网来修复疝。术后其余时间无异常。由椎弓根螺钉移位引起的医源性 DH 以前从未被描述过。在脊柱手术后出现胸腔积液的情况下，快速评估和治疗至关重要。我们得出结论，对于血流动力学稳定且 CT 检查结果为阴性的患者，腹腔镜治疗医源性 DH 可能是可行且有效的，因为它可以完成诊断级联并修复撕裂，提供对腹部内脏和膈肌撕裂的出色可视化。
