Incarcerated intrapericardial diaphragmatic hernia after laparoscopic pericardial window for malignant pericardial effusion

Laparoscopic Pericardial Window (LPW) is a safe, minimally invasive surgical technique for treating pericardial effusion/tamponade. This technique allows adequate decompression and avoids single-lung ventilation and the need for thoracic drainage in severely ill patients; it also provides anatomopathological and microbiological diagnosis leading to treatment measures. An intrapericardial diaphragmatic hernia is among the rarest complications of this procedure. A 85-year-old man, who underwent LPW for pericardial tamponade, presented to the emergency department 12 days post-operative with bowel obstruction; CT scan showed an incarcerated hernia into the pericardial sac. Laparoscopic reduction and hernia repair were performed using a large-pore Mesh to allow further drainage of histologically proven malignant pericardial effusion.