Tension pneumothorax precluding laparoscopic repair of diaphragmatic hernia

Pneumothorax can result from laparoscopic procedures in the abdomen. Usually, pneumothoraxes are mild and asymptomatic and do not require conversion to an open procedure. We report a case of tension pneumothorax that developed during the course of a laparoscopic repair of a diaphragmatic hernia. In this patient, the tension pneumothorax did not respond to conventional means of therapy and required conversion to a laparotomy. A large diaphragmatic hernia with communication between the peritoneal and pleural cavities may be a contraindication to minimally invasive laparoscopic procedures.