DISCUSSION
An irretrievable colonoscope secondary to looping is an exceedingly rare complication of colonoscopy; the presence of previous abdominal surgery is a risk factor for procedural difficulty and incompleteness1-3. Significant looping and angulations are reported to cause the colonoscope to be difficult to advance or retrieve, requiring a laparotomy to withdraw it2-4.
In this case report, the rare complication of colonoscope’s migration in the chest cavity was associated to the presence of a late TDH. The TDH is more commonly associated with blunt abdominal injury like road traffic accident and fall from height when compared with penetrating abdominal injuries and has higher tendency to increase in size and include abdominal organs as the increasing abdominal pressure causes the abdominal content to herniate into the pleural cavity which has relatively lower pressure5.
It is not uncommon for the TDH to remain asymptomatic and have a delayed presentation with potentially serious consequences, as demonstrated by this case.
The literature shows few cases reported of colonoscopes stuck in incarcerated hernias which required surgical management and none of the reported cases were diaphragmatic hernias2-4.
In these cases, a meticulous planning is essential, and it involves a collegial team discussion with different specialist. The surgical strategy should focus on the retrieval of the colonoscope with simultaneous reduction of the TDH; this may represent a challenging situation in view of the previous abdominal adhesions.
In this case report, despite the colonoscope was easily withdraw per rectum, after temporary reduction of the hernial sac, the TDH could not fully be reduced in the abdomen., for the hard adhesion on the abdominal versant. A limited enlargement of the hernial orifice was performed respecting the hernial contents in a view to avoid any future strangulation; this enlargement was also limited to prevent future progression of the herniation process.