Fig. 2

Intraoperative findings and the resulting schema. Surgical exploration showing diaphragmatic laceration and herniation of the sigmoid colon into the thoracic cavity. The finger passing from the abdominal cavity into the thoracic cavity (a). The forceps grasped the diaphragmatic stump attached to the pericardium. The diaphragm is widely ruptured (arrow heads), and the omentum and liver herniate into the thoracic cavity (b). The descending aorta, where aortic dissection had occurred, is visible in the thoracic cavity (c). The surgical schema depicts the repair of the diaphragm, as illustrated by the red curved lines, utilizing horizontal mattress suture fixation (d). The green suture lines indicate the fixation of the diaphragm and mesh to the sixth, seventh, and ninth intercostal spaces from the abdominal cavity (e)