Severe delayed diaphragmatic hernia with total gastric migration after cytoreductive surgery, a rare complication: A case report

Complete cytoreductive surgery is the cornerstone of advanced ovarian cancer management. Diaphragmatic resection may be necessary to remove any residual disease, a procedure that rarely leads to diaphragmatic hernia, a potentially life-threatening complication. The present case report describes a woman with high-grade serous ovarian adenocarcinoma treated with neoadjuvant chemotherapy followed by interval cytoreductive surgery that included bilateral diaphragmatic peritoneal stripping. At 4 months postoperatively, the patient presented with a first sub-occlusive syndrome that was managed with medical treatment. After 3 days, the patient presented with complete bowel obstruction, multiorgan failure and shock. Imaging showed a left diaphragmatic hernia with intrathoracic gastric migration. Emergency surgery confirmed the diagnosis of diaphragmatic hernia and corrected the problem. Though the patient did not experience a recurrence of her diaphragmatic hernia, they did however present with a disease relapse and succumbed 1 year later. Delayed diaphragmatic hernia is a rare, but severe complication of cytoreductive surgery. Computed tomography imaging is key to diagnosis. Surgical repair remains the mainstay of treatment. Known risk factors include diaphragmatic resection, hyperthermic intraperitoneal chemotherapy and bevacizumab, none of which were present in the present case report. This case underscores the importance of recognizing malnutrition as a major risk factor for delayed diaphragmatic hernia following cytoreductive surgery.