Renal Replacement by Thoracic Approach in Traumatic Diaphragmatic Hernia with Thoracic Kidney: Case Report

Abstract

An acquired diaphragmatic hernia usually occurs after thoracoabdominal trauma, causing a defect in the diaphragm that allows the migration of intraperitoneal structures into the thoracic cavity. The finding of renal involvement has a low incidence. The diagnosis of diaphragmatic hernias is based on chest x-ray and computed tomography. Treatment is surgical, due to the risk of strangulation, and consists of content reduction, resection of the sac, and closure of the hernia defect. It can be performed through the thoracic or abdominal approach, with an increasing number of minimally invasive techniques, which reduce trans and postoperative complications. We present the case of a patient with a diagnosis of late-onset post-traumatic diaphragmatic hernia with renal involvement, treated surgically through a thoracic approach with an attempt to preserve the kidneys, who finally underwent nephrectomy due to urinoma secondary to a lesion of the renal pelvis during the mobilization of the kidney to the abdominal cavity.