Small Bowel Does Not Belong in the Pericardium: Case of a Traumatic Intrapericardial Diaphragmatic Hernia

Intrapericardial diaphragmatic hernia (IPDH) is rare and most often a sequela of blunt thoracic trauma. The trans-abdominal or thoracic repair approaches are based on the acuteness of presentation and the expectation of encountering intrapericardial adhesions. We present an acute IPDH in an 80-year-old female patient managed with a laparoscopic trans-abdominal repair. Misdiagnosis and complications from the delayed presentation can be avoided with careful attention to the initial exam, imaging, and early operative repair if the patient is a candidate for the trans-abdominal approach.