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Background  Diaphragmatic hernia is frequent among the elderly and is usually associated with mild chronic digestive and respiratory symptoms.    Case presentation  An elderly post-esophagectomy male patient, in the early postoperative period of cardiac surgery, presented with acute respiratory distress. An emergent surgery was performed to reduce a giant diaphragmatic herniation.    Conclusions  An acute transhiatal herniation can cause serious respiratory impairment; surgical repair should be considered in select patients of cardiac surgery.

Post esophagectomy diaphragmatic hernia: a case report of a rare cause of acute respiratory distress