Diaphragm perforation during laparoscopic left adrenalectomy

The use of laparoscopic methods of surgery accessible to classic surgery until now involves a risk of intra-operative and postoperative complications. Here we report a case of a 74-year old female patient with a very rare iatrogenic lesion of the left leaf of the diaphragm that occurred during laparoscopic adrenalectomy, resulting in parietal incarceration of the colon\'s splenic flexure followed by necrosis and perforation of the intestine and, subsequently, colo-pleural fistula with faecal pleuritis and pleural empyema. The case study shows that perforation of the diaphragm resulted from the use of monopolar electrosurgery during the intervention. There is also a possibility that the large intestine could have burned and perforated in the same way. It appears, however, that colo-pleural fistula was caused by incarceration of the large intestine in the hole of the diaphragm. Subsequently necrosis of the large intestine appeared and faecal contents got through to the pleura. The aim of the corrective procedure was to close the fistula, to suture the injured diaphragm and to eliminate the thoracic empyema by videothoracoscopy. Complications which may appear in laparoscopic surgeries related to the use of electrocoagulation are an important clinical issue endangering human life.