Abstract

A 73-year-old patient was presented from the rehabilitation clinic via the emergency department. The patient had been admitted for rehabilitation after a right hemihepatectomy four months before. After admission despite calculated antibiotic therapy and oxygen administration, the patient's condition worsened peracutely on the following day with clinical dyspnoea, tachycardia, hypotension and somnolence and now also vomiting and diarrhoea. The emergency chest X-ray showed a tension pneumothorax on the right side with severe mediastinal displacement. After emergency thoracal-drainage, abundant brown secretions were discharged. The subsequent CT scan revealed the cause: a diaphragmatic defect with herniation of the right colonic flexure and subsequent gangrene, which had led to perforation and finally to a faecal pleurisy and peritonitis. Exploratory laparotomy, right hemicolectomy, transdiaphragmatic decortication and lavage with drainage and subsequent diaphragmatic reconstruction were performed. Diaphragmatic injuries after partial liver resection are a rare but life-threatening complication, which can also occur at different times. In the case of tension pneumothorax, a diaphragmatic injury should always be considered, which can occur post-traumatically, postoperatively or post-interventionally.

Keywords: Colonic perforation postoperative; Diaphragmatic hernia; Faecothorax; Pleural empyema; Post-hemihepatectomy; Tension pneumothorax