REVISTA CIENCIAS BÁSICAS EN SALUD, 4(3):115-121. JULIO 2026, ISSN 2981-5800  
HERNIA DIAFRAGMÁTICA IATROGÉNICA POSTERIOR A  
TORACOSCOPIA. REPORTE DE CASO.  
IATROGENIC DIAPHRAGMATIC HERNIA AFTER THORACOSCOPY.  
CASE REPORT.  
Valentina Agudelo Marín1, Andrés Villada Duque2, Fernando Arango-Gómez3  
Recibido: 15 de Enero de 2026.  
Aprobado: 15 de Marzo de 2026  
RESUMEN  
La hernia diafragmática es una complicación iatrogénica poco frecuente, con  
Introducción:  
manifestaciones tardías e inespecíficas, lo que dificulta su diagnóstico.  
Presentación del  
Se presenta un caso clínico en una mujer de 32 años con hernia diafragmática  
caso:  
iatrogénica tras decorticación pulmonar por toracoscopia debido a tuberculosis pleural.  
Al tratarse de una complicación de muy baja frecuencia, es fundamental  
Conclusión:  
mantener un alto índice de sospecha para un diagnóstico precoz y una intervención  
inmediata.  
Hernia diafragmática, cirugía mínimamente invasiva, cirugía  
Palabras clave:  
toracoscópica, hernia diafragmática iatrogénica  
ABSTRACT  
Diaphragmatic hernia is a rare iatrogenic complication with late and  
Introduction:  
nonspecific manifestations, making diagnosis difficult.  
We present a  
Case presentation:  
clinical case of a 32-year-old woman with iatrogenic diaphragmatic hernia following  
pulmonary decortication via thoracoscopy for pleural tuberculosis. Given the  
Conclusion:  
exceptionally low frequency of this complication, maintaining a high index of suspicion is  
essential for early diagnosis and immediate intervention.  
diaphragmatic hernia, minimally invasive surgery, thoracoscopic surgery,  
Keywords:  
Iatrogenic diaphragmatic hernia  
Introduction:  
diaphragm. Diaphragmatic hernias are  
classified as congenital and acquired [1].  
The acquired ones are due to closed chest  
trauma with an incidence of 73 to 88% and  
Diaphragmatic Hernia is defined as the  
passage of abdominal contents into the  
thoracic cavity through a defect in the  
Cómo citar este artículo: Agudelo Marín V, Villada Duque A, Arango-Gómez F. Hernia diafragmática iatrogénica  
posterior a toracoscopia. Reporte de caso, Revista Ciencias Básicas En Salud, 4(3):115-121. Julio 2026, ISSN 2981-5800  
REVISTA CIENCIAS BÁSICAS EN SALUD, 4(3):115-121. JULIO 2026, ISSN 2981-5800  
penetrating trauma 12 to 23% of the cases  
[1]; the iatrogenic cause, secondary to  
surgical interventions, is still rare [2,3].  
Cases have been reported after surgeries,  
including diverse types of approaches  
The patient returned in March due to  
symptoms of intense abdominal pain, in  
the epigastrium, accompanied by nausea  
and involuntary abdominal defense. A CT  
scan was performed, in which the  
presence of colonic loops in the left  
hemithorax was observed, with secondary  
pulmonary atelectasis and left pleural  
effusion (Figure 1.a). Given the findings,  
such  
as  
sternotomy,  
laparoscopy,  
thoracoscopy, and thoracotomy [4]; and  
procedures such as esophagectomy,  
gastrectomy, nephrectomy, hepatectomy,  
cholecystectomy,  
splenectomy,  
and  
diaphragmatic  
elevation and  
hernia  
with  
colonic  
lobectomy [1,2,4,5].  
secondary  
intestinal  
obstruction was diagnosed. She was  
taken to surgery for hernia correction by  
minimally invasive technique, where  
elevation of the left colon and omentum to  
the left pleural cavity was found, without  
signs of ischemia or perforation, in  
addition to severe pleural thickening and  
atelectasis (Figure 1.b and c). Initially, a  
We present a female patient with a history  
of pulmonary decortication plus  
pleurectomy by means of video-assisted  
thoracoscopy (VATS) in relation to pleural  
tuberculosis, who consulted 2 months later  
due to intestinal pseudo-obstruction,  
where a left diaphragmatic hernia was  
diagnosed. She was taken to immediate  
surgical correction using a minimally  
invasive technique.  
thoracic  
approach  
pleural  
was  
performed,  
by  
removing  
membranes  
thoracoscopy, achieving adequate lung  
expansion. Then an abdominal approach  
by laparoscopy, peritoneal adhesions  
were released and the hernia content was  
reduced by traction.  
Case presentation  
A
32-year-old  
woman  
underwent  
decortication by VATS in December 2021  
for symptomatic left pleural effusion, at a  
hospital in the United States, Washington  
DC. She consulted again in Colombia in  
January 2022 for the same clinical picture,  
for which a chest CT scan was performed  
with evidence of left pleural effusion and  
pleural thickening on the lower left section.  
Pleural tuberculosis was suspected, so  
she was taken once again to decortication  
plus pleurectomy and insertion of a chest  
tube, with respective histological and  
microbiological studies.  
The  
diaphragmatic  
defect  
was  
approximately 3 cm in diameter located in  
the anterolateral portion of the diaphragm.  
Subsequently, the defect was sutured,  
completing its correction, and a chest tube  
was inserted (Figure d). The postoperative  
course had a good clinical evolution,  
without signs of intestinal obstruction or  
respiratory symptoms. Control CT showed  
evidence of complete hernia correction,  
without signs of perforation of the hollow  
viscus or free fluid in the abdominal cavity,  
with minimal pleural effusion and residual  
The control X-ray showed complete lung  
expansion  
and  
well-positioned  
pneumothorax  
associated  
with  
the  
thoracostomy, with good clinical evolution,  
for which reason she was discharged with  
diagnosis of pleural effusion secondary to  
pleural tuberculosis.  
intervention, for which she was discharged  
on the fourth day of hospitalization.  
Outpatient follow-up had a good clinical  
Cómo citar este artículo: Agudelo Marín V, Villada Duque A, Arango-Gómez F. Hernia diafragmática iatrogénica  
posterior a toracoscopia. Reporte de caso, Revista Ciencias Básicas En Salud, 4(3):115-121. Julio 2026, ISSN 2981-5800  
REVISTA CIENCIAS BÁSICAS EN SALUD, 4(3):115-121. JULIO 2026, ISSN 2981-5800  
evolution, with absence of symptoms or  
sequelae related to the event.  
lead to a delay in diagnosis in many cases  
with an increased incidence of acute  
complications such as incarceration,  
strangulation or perforation, and chronic  
complications such as weight loss,  
malnutrition and physical deconditioning,  
loss of functionality and aerobic capacity;  
which produce a high mortality rate, up to  
30% in case of strangulation [1,5,7]. There  
is a risk of death secondary to respiratory  
failure or cardiac tamponade, due to chest  
compression, and infarction or visceral  
perforation, due to compromised intestinal  
blood supply, but with an unknown specific  
incidence [13].  
Discussion  
Iatrogenic diaphragmatic hernia is a rare  
event  
with  
an  
unknown  
incidence  
depending on the surgery performed  
[3,5,6]. These are frequently seen after  
esophagectomies  
and  
rarely  
after  
thoracoscopies like the one presented in  
this case [2.6]. Within the reviewed  
literature, only six reports were found after  
thoracic surgery [2,5,7-10].  
Several theories of the possible etiology  
are presented, the direct injury to the  
diaphragm by incision during surgery  
inadvertently and then unidentified, the  
use of electrical elements such as  
electrocautery or coagulation scissors that  
cause direct damage to the diaphragm by  
diathermy with late necrosis, or by the  
insertion of drains such as thoracostomy  
[4,5,11,12].  
Diagnosis is made through imaging  
studies, the most efficient and cost-  
effective  
test  
being  
computerized  
tomography (CT), with a sensitivity of 78%  
for left hernias and 50% for right hernias  
[14-16]. Although simple radiography,  
thoracic  
nuclear  
and  
abdominal  
and  
ultrasound,  
endoscopic  
resonance,  
studies have been used, they have lower  
performance or cost effectiveness than CT  
[13-16]. Lastly, there is laparoscopy as a  
diagnostic and therapeutic method, but  
with higher risks compared to diagnostic  
images, as it is an invasive technique [14-  
15].  
The hernia can remain asymptomatic for a  
prolonged period, generating delays in the  
diagnosis, thus allowing the progressive  
extension of the hernial defect thanks to  
the pleuroperitoneal pressure gradient that  
allows the passage of viscera into the  
pleural cavity [1,3,7]. Symptoms can  
appear months or even years after the  
initial injury, as in this case where  
symptoms appeared 2 months after the  
thoracic surgery [1,7]. When these come  
The gold standard treatment is surgical  
correction, indicated when symptoms  
appear with evidence of diaphragmatic  
hernia by diagnostic images [1,6]. Ten  
percent mortality during surgery has been  
reported. 20 to 60% of surgeries are  
performed in emergency situations, in  
which case mortality can rise from 20 to  
80% [1,5]. Minimally invasive surgery is  
preferred, even though more than 42%  
may be converted to open surgery due to  
complications such as intestinal gangrene,  
out,  
symptoms such as abdominal pain,  
nausea, vomiting, gastroesophageal  
they  
may  
be  
gastrointestinal  
reflux, feeling of fullness, abdominal  
distension or frank symptoms of intestinal  
obstruction; respiratory symptoms such as  
dyspnea and cough may also occur and  
cardiac symptoms such as chest pain  
[1,2,5,12]. These non-specific symptoms  
Cómo citar este artículo: Agudelo Marín V, Villada Duque A, Arango-Gómez F. Hernia diafragmática iatrogénica  
posterior a toracoscopia. Reporte de caso, Revista Ciencias Básicas En Salud, 4(3):115-121. Julio 2026, ISSN 2981-5800  
REVISTA CIENCIAS BÁSICAS EN SALUD, 4(3):115-121. JULIO 2026, ISSN 2981-5800  
splenic injury, inability to reduce the  
hernia, and tension pneumothorax [6].  
systematically the integrity of the tissues  
before leaving the cavity [6].  
The surgical approach depends on the  
preference and expertise of the surgeon.  
With the advent of minimally invasive  
surgery, both thoracic and abdominal, it is  
considered the preferred technique given  
the advantages related to less bleeding,  
less postoperative pain, reduced risk of  
infection, shorter recovery time, better  
visualization of the hernia content and less  
need for mechanical ventilation compared  
to the open technique [1,5,6,15]. In this  
case, thoracoscopic plus laparoscopic  
approach was performed.  
Figure 1.a. CT scan that shows the  
presence of colonic loops in the left  
hemithorax, with secondary pulmonary  
atelectasis and left pleural effusion.  
Treatment of asymptomatic hernia is still  
controversial, in some series expectant  
management has been indicated, which  
confers  
the  
risk  
of  
unpredictable  
complications [1,17]. The use of meshes  
to reduce recurrences is also controversial  
since they can cause more complications  
such as visceral erosion or infection [18].  
For this reason, direct suture is still  
preferred as the standard method and the  
use of mesh is left only when the least  
possible tension on the suture is needed in  
large defects and the inability to correction  
due to loss of substance of the diaphragm  
or the presence of weak tissues, as it has  
been shown to reduce the risk of  
recurrence [6,13,14,18]. Early diagnosis is  
essential to avoid complications that can  
have catastrophic outcomes, even leading  
to the death of the patient [1].  
Figure 1.b and c. Elevation of the left  
colon and omentum to the left pleural  
cavity, without signs of ischemia or  
perforation, in addition to severe pleural  
thickening and atelectasis.  
Figure d. The defect was sutured.  
To prevent iatrogenic diaphragmatic  
hernias, it has been proposed to minimize  
diaphragmatic injury during surgery by  
taking unusual care and attention now of  
insertion of the ports, always correcting  
Conclusion  
A case of iatrogenic diaphragmatic hernia  
secondary  
to  
thoracic  
surgery  
is  
presented, being a very infrequent event.  
It is important to detect it early, having a  
high index of suspicion when symptoms  
pre-existing  
hernias  
and  
visualizing  
Cómo citar este artículo: Agudelo Marín V, Villada Duque A, Arango-Gómez F. Hernia diafragmática iatrogénica  
posterior a toracoscopia. Reporte de caso, Revista Ciencias Básicas En Salud, 4(3):115-121. Julio 2026, ISSN 2981-5800  
REVISTA CIENCIAS BÁSICAS EN SALUD, 4(3):115-121. JULIO 2026, ISSN 2981-5800  
appear  
after  
thoracoabdominal  
2016;8:e399-e402.  
Doi:  
interventions and with imaging control  
after surgical interventions that can  
compromise the diaphragm, to make an  
10.21037/jtd.2016.04.14.  
6. Erdas E, Canu GL, Gordini L, et al.  
Emergency laparoscopic repair of  
giant left diaphragmatic hernia  
immediate  
intervention  
and  
avoid  
complications related to the procedure.  
following  
minimally  
invasive  
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Cómo citar este artículo: Agudelo Marín V, Villada Duque A, Arango-Gómez F. Hernia diafragmática iatrogénica  
posterior a toracoscopia. Reporte de caso, Revista Ciencias Básicas En Salud, 4(3):115-121. Julio 2026, ISSN 2981-5800  
REVISTA CIENCIAS BÁSICAS EN SALUD, 4(3):115-121. JULIO 2026, ISSN 2981-5800  
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1
University of Manizales Faculty of Health Sciences, Manizales, Colombia,  
valen.agu.va@gmail.com, ORCID 0009-0003-69486133  
2 International Hospital of Colombia, anvillada@yahoo.com, ORCID 0009-0000-1113-6489,  
3
University of Manizales Faculty of Health Sciences, Manizales, Colombia,  
fernando.arango64@gmail.com, ORCID 0000-0003-4811-8908  
Cómo citar este artículo: Agudelo Marín V, Villada Duque A, Arango-Gómez F. Hernia diafragmática iatrogénica  
posterior a toracoscopia. Reporte de caso, Revista Ciencias Básicas En Salud, 4(3):115-121. Julio 2026, ISSN 2981-5800