TY - JOUR
T1 - Spontaneous diaphragmatic rupture following neoadjuvant chemotherapy and cytoreductive surgery in malignant pleural mesothelioma
T2 - A case report and review of the literature
AU - Cattaneo, Margherita
AU - Mendogni, Paolo
AU - Damarco, Francesco
AU - Tosi, Davide
PY - 2020
Y1 - 2020
N2 - Introduction: Diaphragmatic rupture (DR) is an acquired diaphragmatic defect that can cause herniation of abdominal organs into the chest. It is usually a trauma-related lesion, but rarely it can occur spontaneously. Every DR with abdominal herniation should be considered a surgical emergency. Presentation of case: A 61-year-old male patient, with previous exposure to asbestos, was diagnosed of Stage Ib malignant pleural mesothelioma (MPM). He underwent neo-adjuvant chemotherapy (three cycle of cisplatin-pemetrexed combination) and a cytoreductive surgery with pleurectomy/decortication. Post-operative course was characterized by prolonged air-leakage (PAL). After three months, during a follow-up CT-scan, a spontaneous diaphragmatic rupture (SDR) with gastric herniation was detected and treated by a laparascopic diaphragmatic repair and suture. Discussion: Spontaneous diaphragmatic rupture (SDR) is an extremely rare injury of the diaphragm (less than 1% of all DR). In this case, potential predisposing factors for SDR could be: presence of diaphragmatic “locus minoris resistentiae” due to thinning of the diaphragm and increase tissue fragility after neo-adjuvant chemotherapy and diaphragmatic pleural stripping; increased thoraco-abdominal pressure gradient due to PAL and residual pleural space. Thus, we confirmed the feasibility and safety of the laparoscopic approach. Conclusion: We highlight the multifactor etiopathology, the challenging diagnosis and the importance of a prompt treatment of SDR.
AB - Introduction: Diaphragmatic rupture (DR) is an acquired diaphragmatic defect that can cause herniation of abdominal organs into the chest. It is usually a trauma-related lesion, but rarely it can occur spontaneously. Every DR with abdominal herniation should be considered a surgical emergency. Presentation of case: A 61-year-old male patient, with previous exposure to asbestos, was diagnosed of Stage Ib malignant pleural mesothelioma (MPM). He underwent neo-adjuvant chemotherapy (three cycle of cisplatin-pemetrexed combination) and a cytoreductive surgery with pleurectomy/decortication. Post-operative course was characterized by prolonged air-leakage (PAL). After three months, during a follow-up CT-scan, a spontaneous diaphragmatic rupture (SDR) with gastric herniation was detected and treated by a laparascopic diaphragmatic repair and suture. Discussion: Spontaneous diaphragmatic rupture (SDR) is an extremely rare injury of the diaphragm (less than 1% of all DR). In this case, potential predisposing factors for SDR could be: presence of diaphragmatic “locus minoris resistentiae” due to thinning of the diaphragm and increase tissue fragility after neo-adjuvant chemotherapy and diaphragmatic pleural stripping; increased thoraco-abdominal pressure gradient due to PAL and residual pleural space. Thus, we confirmed the feasibility and safety of the laparoscopic approach. Conclusion: We highlight the multifactor etiopathology, the challenging diagnosis and the importance of a prompt treatment of SDR.
KW - Case report
KW - Diaphragmatic herniation
KW - Malignant pleural mesothelioma
KW - Spontaneous diaphragmatic rupture
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U2 - 10.1016/j.ijscr.2020.09.073
DO - 10.1016/j.ijscr.2020.09.073
M3 - Article
AN - SCOPUS:85091848638
VL - 77
SP - S85-S87
JO - International Journal of Surgery Case Reports
JF - International Journal of Surgery Case Reports
SN - 2210-2612
IS - Suppl.
ER -