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While most diaphragmatic hernias are congenital or trauma-acquired, iatrogenic diaphragmatic hernias are exceedingly rare and often present with delayed, nonspecific, subacute symptoms and equivocal imaging. This case report describes an iatrogenic diaphragmatic hernia after thoracoscopic pleural endometriosis removal, complicated by gastric strangulation and perforation, leading to life-threatening tension pneumothorax, managed using an entirely laparoscopic approach.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/management-of-strangulated-perforated-gastrothorax-with-resultant-tension-pneumothorax-secondary-to-iatrogenic-diaphragmatic-hernia-a-case-report/440686/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/management-of-strangulated-perforated-gastrothorax-with-resultant-tension-pneumothorax-secondary-to-iatrogenic-diaphragmatic-hernia-a-case-report/440686.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What complication sequence occurred in this case?","Question",{"text":113,"@type":114},"After an iatrogenic diaphragmatic hernia developed following thoracoscopic surgery, gastric strangulation and perforation progressed to a life-threatening tension pneumothorax.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why are iatrogenic diaphragmatic hernias difficult to diagnose?",{"text":118,"@type":114},"They tend to present with delayed, varied, nonspecific, and subacute symptoms, and radiographic findings may be equivocal or indeterminate.",{"name":120,"@type":111,"acceptedAnswer":121},"How was the surgical emergency managed?",{"text":122,"@type":114},"The authors report management using an entirely laparoscopic technique, and they contextualize the approach with relevant literature on complicated diaphragmatic hernias.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},440686,1790759896,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Journal of Surgical Case Reports, 2026, 1, rjaf1033  \n[https://doi.org/10.1093/jscr/rjaf1033](https://doi.org/10.1093/jscr/rjaf1033)  \nCase Report  \nCase Report  \nManagement of strangulated, perforated gastrothorax with resultant tension pneumothorax secondary to aniatrogenic diaphragmatic hernia: a case report  \nAndrea Naim *, Anik Sarkar  \nDepartment of Surgery, Wollongong Hospital, Loftus Street, Wollongong 2500, New South Wales, Australia  \n*Corresponding author. Department of Surgery, Wollongong Hospital, Loftus Street, Wollongong 2500, New South Wales, Australia.  \nE-mail: [andrea.j.naim@gmail.com](andrea.j.naim@gmail.com)  \nAbstract  \nDiaphragmatic hernias arise when a defect in the diaphragmatic musculotendinous framework allows the abnormal protrusion of abdominal contents into the thoracic cavity, which can be further complicated by visceral incarceration, strangulation, and perforation. Whilst the vast majority occur congenitally or are acquired through trauma, diaphragmatic hernias arising from iatrogenic insults represent an exceedingly rare but important clinical entity. Diagnostic challenges arise in large part due to their tendency towards delayed presentation, often with varied, nonspecific and subacute clinical manifestations, as well as equivocal or indeterminate radiographic findings. The report herein represents the inaugural account of an iatrogenic diaphragmatic hernia arising following thoracoscopic pleural endometriosis removal, which was subsequently complicated by gastric strangulation and perforation, culminating in a lifethreatening tension pneumothorax. We describe a safe, effective approach to managing this surgical emergency using an entirely laparoscopic technique and relate our findings to the broader literature pertaining to complicated diaphragmatic hernias.  \nKeywords: iatrogenic diaphragmatic hernia; gastrothorax; gastric perforation; tension pneumothorax; video-assisted thoracoscopic surgery; laparoscopy  \nIntroduction  \nDiaphragmatic hernias (DH) arise when a defect in the musculotendinous framework of the diaphragm allows the abnormal protrusion of abdominal contents into the thoracic cavity. Most DHs are congenital, attributed to abnormal diaphragmatic embryogenesis. Acquired DHs typically arise later in life, usually from blunt or penetrating traumatic injury. Iatrogenic diaphragmatic hernias (IDH) are an exceptionally rare subtype of acquired DH, as evidenced by being exclusively reported in limited case reports and series. Most reported cases have occurred following abdominal surgery, with paediatric liver transplantation or resection being the commonest aetiologies [1 , 2] .  \nWe present the unique case of a 29-year-old woman who developed an IDH following video-assisted thoracoscopic surgery (VATS) for diaphragmatic endometriosis removal, which was further complicated by tension pneumothorax secondary to gastric perforation. To our knowledge, this is the first documented account of such an occurrence. We describe a safe, effective approach to managing this surgical emergency using an entirely laparoscopic technique and contextualize our findings within  \nbroader research as it pertains to the management of complicated DHs.  \nCase report  \nA 29-year-old female presented in February 2025 with suddenonset, severe left-sided pleuritic chest pain, nausea, and vomiting. Her background was significant for endometriosis with diaphragmatic involvement. Having failed to achieve appreciable symptom control with medical therapies, she had travelled overseas in September 2024, where she underwent bilateral VATS and excision of multiple endometriosis lesions from the diaphragmatic pleural surface.  \nOn initial examination, she was haemodynamically stable, with epigastric and left upper quadrant tenderness, but no peritonism. A venous blood gas showed a lactate of 2 . 7, but no acid– base disturbance or respiratory failure. Chest X-ray (CXR) revealed left hemidiaphragm effacement and a large air","cbCaicSbM8UU6e25","https://ap.wps.com/l/cbCaicSbM8UU6e25","pdf",710934,"English","# Abstract\n# Keywords\n# Introduction\n# Case report\n## Presentation and initial assessment\n## Imaging findings","[{\"question\":\"What complication sequence occurred in this case?\",\"answer\":\"After an iatrogenic diaphragmatic hernia developed following thoracoscopic surgery, gastric strangulation and perforation progressed to a life-threatening tension pneumothorax.\"},{\"question\":\"Why are iatrogenic diaphragmatic hernias difficult to diagnose?\",\"answer\":\"They tend to present with delayed, varied, nonspecific, and subacute symptoms, and radiographic findings may be equivocal or indeterminate.\"},{\"question\":\"How was the surgical emergency managed?\",\"answer\":\"The authors report management using an entirely laparoscopic technique, and they contextualize the approach with relevant literature on complicated diaphragmatic hernias.\"}]","Management of strangulated, perforated gastrothorax with resultant tension pneumothorax secondary to iatrogenic diaphragmatic hernia: a case report | PDF",1790692959,13]