Alexandra  Argiroff,Diego  Camacho,Victoria  Needham,
The Tip of The Iceberg: An Unusual Case of Diaphragmatic Hernia Presenting as A Breast Abscess
Surgical Case Reports
2019
2613-5965
http://dx.doi.org/10.31487/j.SCR.2019.01.012
https://www.sciencerepository.org/the-tip-of-the-iceberg-an-unusual-case-of-diaphragmatic-hernia-presenting-as-a-breast-abscess_SR-SCR-2019-1-112 
Abstract: In this case report we illustrate an atypical presentation of diaphragmatic hernia as a colocutaneous fistula.
An 83-year-old female with history inclusive of hiatal hernia repair and multiple ventral hernia repairs
presented with purulence from her left breast. CT scan was performed showing a colon-containing
diaphragmatic hernia protruding between left-sided ribs, with an overlying left breast collection. She was
taken to the OR, and after extensive lysis of adhesions, a large left diaphragmatic hernia was encountered
with perforated colonic diverticulitis in the hernia sac extending to the colocutaneous fistula via the breast.
The hernia sac was dissected down, the colon was mobilized, and a left segmental colectomy was
performed to include the area of involved pathology, with primary anastomosis, and the diaphragmatic
defect was repaired primarily. It is important to consider unusual presentations of diaphragmatic hernia,
including any pathology involving any intraabdominal organs incarcerated within the defect.Keywords: diaphragmatic hernia, ventral hernia, colocutaneous fistula, diverticulitis, reoperation