Diaphragmatic hernia caused by heterotopic endometriosis in Chilaiditi syndrome: report of a case

Haratake N, Naoki Haratake, Koji Yamazaki, Yamazaki K, Shikada Y, Yasunori Shikada
Surgery today · 2014 · vol. 45(9) , pp. 1194–1196 · doi:10.1007/s00595-014-1001-6 · PMID:25115928 · W1987059856
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-08 ⓘ

This case report describes a 50-year-old female with Chilaiditi syndrome and ileus who underwent surgery for a right diaphragmatic hernia caused by heterotopic endometriosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This paper reports a 50-year-old Japanese woman admitted with ileus due to Chilaiditi syndrome whose symptoms did not improve with conservative therapy. On day 5, CT imaging identified incarcerated right diaphragmatic hernia with strangulation of a dilated terminal ileum loop within the right thoracic cavity, and emergency surgery was performed with primary diaphragmatic closure and resection/reconstruction of approximately 80 cm of ischemic terminal ileum. Histology of tissue around the hernia orifice found a cystiform glandular system with hemorrhage and congestion, indicating heterotopic endometriosis in the diaphragm. The paper states it is the first known case of a right diaphragmatic hernia secondary to heterotopic endometriosis in Chilaiditi syndrome and includes a literature review of these three unusual conditions. This paper is centrally about endometriosis — specifically a case of diaphragmatic hernia caused by heterotopic endometriosis in the setting of Chilaiditi syndrome.

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Abstract

A 50-year-old Japanese female was admitted to our hospital because of ileus due to Chilaiditi syndrome. Her symptoms did not improve with conservative therapy, so chest and abdominal computed tomography (CT) was performed on the fifth day after hospital admission. A diagnosis of incarceration of a right diaphragmatic hernia was established in the coronal view of CT, and emergency surgery was performed. A dilated loop of small intestine was seen in the right thoracic cavity, which was strangulated by the 2-cm defect in the diaphragm. Primary closure of the diaphragm was performed. Approximately 80 cm of the terminal ileum showed obvious ischemic changes, and it was cut and reconstructed. Postoperatively, the patient made an uneventful recovery and was discharged on the 15th postoperative day. A histological examination of the specimen of the diaphragm around the hernia orifice showed the presence of a small cystiform glandular system with hemorrhage and congestion. These findings indicated that heterotopic endometriosis was present in the diaphragm. This report describes the first known case of right diaphragmatic hernia secondary to heterotopic endometriosis in a patient with Chilaiditi syndrome. The clinical course and management of affected patients and a literature review of these three unusual conditions are discussed.
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Abstract

A 50-year-old Japanese female was admitted to our hospital because of ileus due to Chilaiditi syndrome. Her symptoms did not improve with conservative therapy, so chest and abdominal computed tomography (CT) was performed on the fifth day after hospital admission. A diagnosis of incarceration of a right diaphragmatic hernia was established in the coronal view of CT, and emergency surgery was performed. A dilated loop of small intestine was seen in the right thoracic cavity, which was strangulated by the 2-cm defect in the diaphragm. Primary closure of the diaphragm was performed. Approximately 80 cm of the terminal ileum showed obvious ischemic changes, and it was cut and reconstructed. Postoperatively, the patient made an uneventful recovery and was discharged on the 15th postoperative day. A histological examination of the specimen of the diaphragm around the hernia orifice showed the presence of a small cystiform glandular system with hemorrhage and congestion. These findings indicated that heterotopic endometriosis was present in the diaphragm. This report describes the first known case of right diaphragmatic hernia secondary to heterotopic endometriosis in a patient with Chilaiditi syndrome. The clinical course and management of affected patients and a literature review of these three unusual conditions are discussed.

References

Newman BM, Afshani E, Karp MP, Jewett TC Jr, Cooney DR. Presentation of congenital diaphragmatic hernia past the neonatal period. Arch Surg. 1986;121:813–6. Hanna WC, Ferri LE, Fata P, Razek T, Mulder DS. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg. 2008;85:1044–8. Soufi M, Meillat H, Le Treut YP. Right diaphragmatic iatrogenic hernia after laparoscopic fenestration of a liver cyst: report of a case and review of the literature. World J Emerg Surg. 2013;8:2. Chatra PS. Thoracic endometriosis: a case report. J Radiol Case Rep. 2012;6:25–30. Cooper MJ, Russell P, Gallagher PJ. Diaphragmatic endometriosis. Med J Aust. 1999;171:142–3. Conflict of interest Naoki Haratake and co-authors have no conflicts of interest. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Haratake, N., Yamazaki, K. & Shikada, Y. Diaphragmatic hernia caused by heterotopic endometriosis in Chilaiditi syndrome: report of a case. Surg Today 45, 1194–1196 (2015). https://doi.org/10.1007/s00595-014-1001-6 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00595-014-1001-6

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Condition tags

endometriosis

MeSH descriptors

Chilaiditi Syndrome Choristoma Endometriosis Hernia, Diaphragmatic Hernia, Diaphragmatic Muscular Diseases Chilaiditi Syndrome Choristoma Diaphragm Endometriosis Female Hernia, Diaphragmatic Humans Middle Aged Muscular Diseases Treatment Outcome

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