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. 1979 Mar;189(3):359–366. doi: 10.1097/00000658-197903000-00018

Intrapericardial diaphragmatic hernia in adults.

R L Meng, A Straus, F Milloy, C F Kittle, H Langston
PMCID: PMC1397088  PMID: 426568

Abstract

Intrapericardial diaphragmatic hernia (IDH) is the rarest type of adult diaphragmatic hernia. Only 28 cases have been reported. Indirect blunt trauma has been implicated in most cases, but one resulted from a stab wound to the anterior chest. Patients presented immediately or up to 20 years following trauma with symptoms of intermittent bowel obstruction, including one with strangulation, or cardiac dysfunction, including dyspnea, palpitations, and two patients with cardiac tamponade. Physical findings included bowel sounds in the chest, decreased heart and lung sounds, and an absent point of maximal cardiac impulse. Chest roentgenography usually revealed supradiaphragmatic gas shadows suggestive of bowel in the chest. Thorough examination of both anteroposterior and lateral chest roentgenograms and barium gastrointestinal series may provide positive diagnosis of anterior diaphragmatic hernia, and fluoroscopy after induced pneumoperitoneum may establish its pericardial involvement. Celiotomy is the preferred approach to surgical repair of IDH. Since the symptoms referable to adult IDH can be incapacitating or life threatening, herniorrhaphy should be performed promptly upon diagnosis, with expectation of an uneventful recovery and negligible recurrence rate.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ASTRUP E. C., ZIESLER E. Hernia diaphragmatica pericardialis. Acta Med Scand. 1951 Dec 12;141(3):153–158. doi: 10.1111/j.0954-6820.1951.tb14205.x. [DOI] [PubMed] [Google Scholar]
  2. Andersen M., Fredens M., Olesen K. H. Traumatic rupture of the pericardium. Am J Cardiol. 1971 May;27(5):566–569. doi: 10.1016/0002-9149(71)90420-6. [DOI] [PubMed] [Google Scholar]
  3. Andrus C. H., Morton J. H. Rupture of the diaphragm after blunt trauma. Am J Surg. 1970 Jun;119(6):686–693. doi: 10.1016/0002-9610(70)90240-0. [DOI] [PubMed] [Google Scholar]
  4. BROOKES V. S. Intrapericardial diaphragmatic hernia. Br J Surg. 1953 Mar;40(163):511–513. doi: 10.1002/bjs.18004016323. [DOI] [PubMed] [Google Scholar]
  5. Bank H., Sinkover H., Ophir M., Shulemson M. Traumatic diaphragmatic transpericardial hernia. Br Med J. 1971 Jun 12;2(5762):629–630. doi: 10.1136/bmj.2.5762.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Beddingfield G. W. Cardiac tamponade due to traumatic hernia of the diaphragm and pericardium. Ann Thorac Surg. 1968 Aug;6(2):178–180. doi: 10.1016/s0003-4975(10)66010-9. [DOI] [PubMed] [Google Scholar]
  7. Borrie J., Lichter I. Pericardial rupture from blunt chest trauma. Thorax. 1974 May;29(3):329–337. doi: 10.1136/thx.29.3.329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. CARTER B. N., GIUSEFFI J., FELSON B. Traumatic diaphragmatic hernia. Am J Roentgenol Radium Ther. 1951 Jan;65(1):56–72. [PubMed] [Google Scholar]
  9. CRAWSHAW G. R. Herniation of the stomach, transverse colon, and a portion of the jejunum into the pericardium. Br J Surg. 1952 Jan;39(156):364–366. doi: 10.1002/bjs.18003915624. [DOI] [PubMed] [Google Scholar]
  10. Coats R. R., Sakai K., Lam C. R. Extensive diaphragmatic-pericardial rupture from blunt trauma. Report of a case, with a review. J Thorac Cardiovasc Surg. 1972 Feb;63(2):275–278. [PubMed] [Google Scholar]
  11. Davis P. W. Traumatic herniation into the pericardial sac. Postgrad Med J. 1968 Nov;44(517):875–878. doi: 10.1136/pgmj.44.517.875. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Deutsch A. A., Brown K. N., Freeman N. V., Stanley D. A. A case of diaphragmatic hernia, absent pericardium, and hamartoma of liver. Br J Surg. 1972 Feb;59(2):156–158. doi: 10.1002/bjs.1800590223. [DOI] [PubMed] [Google Scholar]
  13. ELLIS K., LEEDS N. E., HIMMELSTEIN A. Congenital deficiencies in the parietal pericardium: a review with 2 new cases including successful diagnosis by plain roentgenography. Am J Roentgenol Radium Ther Nucl Med. 1959 Jul;82(1):125–137. [PubMed] [Google Scholar]
  14. HERMAN P. G., GOLDSTEIN J. E. TRAUMATIC INTRAPERICARDIAL DIAPHRAGMATIC HERNIA. Br J Radiol. 1965 Aug;38:631–633. doi: 10.1259/0007-1285-38-452-631. [DOI] [PubMed] [Google Scholar]
  15. Haider R., Thomas D. G., Ziady G., Cleland W. P., Goodwin J. F. Congenital pericardio-peritoneal communication with herniation of omentum into the pericardium. A rare cause of cardiomegaly. Br Heart J. 1973 Sep;35(9):981–984. doi: 10.1136/hrt.35.9.981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Heikkilä J., Luomanmäki K., Karhunen P. Isolated pericardial rupture after blunt chest injury. Scand J Thorac Cardiovasc Surg. 1971;5(2):159–162. doi: 10.3109/14017437109135549. [DOI] [PubMed] [Google Scholar]
  17. Hyatt D. F., Gordon L. A. Abdominal stab wound sinogram demonstrating pericardial penetration. Arch Surg. 1972 Mar;104(3):340–341. doi: 10.1001/archsurg.1972.04180030086020. [DOI] [PubMed] [Google Scholar]
  18. MOORE T. C. Traumatic pericardial diaphragmatic hernia. Arch Surg. 1959 Nov;79:827–830. doi: 10.1001/archsurg.1959.04320110129022. [DOI] [PubMed] [Google Scholar]
  19. McCaughey W., King R. Pneumopericardium associated with tracheal rupture. Management of a case complicated by the shock lung syndrome. Anaesthesia. 1975 Mar;30(2):199–205. doi: 10.1111/j.1365-2044.1975.tb00834.x. [DOI] [PubMed] [Google Scholar]
  20. Melzig E. P., Swank M. S., Salzberg A. M. Acute blunt traumatic rupture of the diaphragm in children. Arch Surg. 1976 Sep;111(9):1009–1011. doi: 10.1001/archsurg.1976.01360270081015. [DOI] [PubMed] [Google Scholar]
  21. O'brien H. D. Pericardio-peritoneal communication, description of a rare type of diaphragmatic hernia. J Anat. 1939 Oct;74(Pt 1):131–134. [PMC free article] [PubMed] [Google Scholar]
  22. Pfaff C., Hunter T. B., Silverstein M. E., Freundlich I. M. Pneumopericardium secondary to a fistula. Communication between pericardium and subphrenic-colonic abscess. JAMA. 1976 Jun 7;235(23K0):2522–2523. doi: 10.1001/jama.235.23.2522. [DOI] [PubMed] [Google Scholar]
  23. ROBB D. Traumatic diaphragmatic hernia into the pericardium. Br J Surg. 1963 May;50:664–666. doi: 10.1002/bjs.18005022418. [DOI] [PubMed] [Google Scholar]
  24. ROGERS J. F., LANE W. Z., GIBBS R. Herniation through the diaphragm into the pericardium. Henry Ford Hosp Med Bull. 1957 Dec;5(4):271–275. [PubMed] [Google Scholar]
  25. SMITH L., LIPPERT K. M. Peritoneopericardial diaphragmatic hernia. Ann Surg. 1958 Nov;148(5):798–804. doi: 10.1097/00000658-195811000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. STEIN J., COLMORE H. P., GREEN R. A. Diaphragmatico-pericardial tear with intrapericardial herniation of the transverse colon. Radiology. 1953 Mar;60(3):417–420. doi: 10.1148/60.3.417. [DOI] [PubMed] [Google Scholar]
  27. Sutton J. P., Carlisle R. B., Stephenson S. E., Jr Traumatic diaphragmatic hernia. A review of 25 cases. Ann Thorac Surg. 1967 Feb;3(2):136–150. doi: 10.1016/s0003-4975(10)66703-3. [DOI] [PubMed] [Google Scholar]
  28. THOMSEN G., VESTERDAL J., WINKEL SMITH C. C. Diaphragmatic hernia into the pericardium. Acta Paediatr. 1954 Sep;43(5):485–492. doi: 10.1111/j.1651-2227.1954.tb04056.x. [DOI] [PubMed] [Google Scholar]
  29. Thomas T. V. Roentgenogram of the month. Right cardiophrenic mass. Chest. 1971 Jul;60(1):87–88. doi: 10.1378/chest.60.1.87. [DOI] [PubMed] [Google Scholar]
  30. Thomas T. V. Subcostosternal diaphragmatic hernia. J Thorac Cardiovasc Surg. 1972 Feb;63(2):279–283. [PubMed] [Google Scholar]
  31. VONBERG V. J., MOGGI L., JACOBSON L. F., JORDAN P., Jr, JOHNSTON C. G. Ten years' experience with penetrating injuries of the heart. J Trauma. 1961 Mar;1:186–194. doi: 10.1097/00005373-196103000-00010. [DOI] [PubMed] [Google Scholar]
  32. Vadlamudi K. K., Savarirayan B., McManus J. E. Pericardial injury demonstrated by sinogram of abdominal stabwound. N Y State J Med. 1975 Jun;75(7):1064–1065. [PubMed] [Google Scholar]
  33. Vigg B., Rai V., Buchilingam Pyo-pneumo pericarditis due to E. coli. Indian Heart J. 1975 Oct;27(4):287–288. [PubMed] [Google Scholar]
  34. WREN H. B., CHAPMAN W. S., PEARCE C. W. Traumatic diaphragmatic intrapericardial hermia. South Med J. 1963 Sep;56:1043–1045. doi: 10.1097/00007611-196309000-00024. [DOI] [PubMed] [Google Scholar]
  35. Wetrich R. M., Sawyers T. M., Haug C. A. Diaphragmatic rupture with pericardial involvement. Report of two cases. Ann Thorac Surg. 1969 Oct;8(4):361–366. doi: 10.1016/s0003-4975(10)66252-2. [DOI] [PubMed] [Google Scholar]

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