Pericardial Hernia After Pericardial Window: A Rare Case.

Diaphragmatic hernias have classically been reported due to congenital birth defects and blunt or penetrating trauma. We present a rare case of an intrapericardial diaphragmatic hernia after left-sided pericardial window surgery for chronic pericardial effusions. A 59-year-old female with a background of systemic lupus erythematosus and recurrent pericardial effusions underwent subxiphoid placement of a pericardial-peritoneal window. Postoperatively, she reported exertional shortness of breath. Imaging revealed a diaphragmatic hernia in the pericardial cavity. Open adhesiolysis between the abdominal organs and the heart was performed via a thoracoabdominal approach followed by suture and mesh repair of the defect. The postoperative course was uneventful. Pericardial hernias are rare, with few published cases. Their etiologies can be traumatic, iatrogenic, or congenital, with variable, non-specific symptoms that may occur at any time after the inciting event. With the potential for significant cardiac compromise, clinicians should be aware of this rare diagnosis, and surgical repair must be prioritized. This case documents the successful surgical management of this rare complication. Careful multidisciplinary planning is essential for surgical repair and should be tailored to patient-specific factors.