A rare case of diaphragmatic hernia after cytoreductive surgery and hypertermic intraperitoneal chemotherapy

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective therapeutic approach for selected patients with gastrointestinal and gynecological malignancies with peritoneal spread. The most frequent postoperative surgical complications are anastomotic leakage, digestive perforations, fistulas, intestinal obstruction, abscess and peripancreatitis. This report presents case of a patient with late postoperative diaphragmatic hernia after CRS and HIPEC. A 50- year-old woman previously treated with CRS and HIPEC for a pseudomyxoma peritonei was admitted to our unit with diagnosis of intestinal obstruction. At the CT scan a left diaphragmatic hernia involving the splenocolic flexure was found. Both stripping of the diaphragmatic peritoneum during CRS, sometimes combined with diaphragmatic resection and the heat of HIPEC might be responsible for such complication. The diaphragmatic hernia is rarely diagnosed after CRS and HIPEC. Surgical techniques for repair can be the direct suture of the defect or closure with synthetic or biological tissue, both are possible surgical techniques for repair with a good long term results