A case of colon necrosis resulting from a delayed traumatic diaphragmatic hernia

Abstract

We present the case of a 71 years old woman who came at the emergency room for abdominal pain and symptoms of occlusion. The scanner demonstrated a colonic occlusion resulting from an incarceration, diagnosed as a hernia of Bochdalek. But two old rib fractures and a past history of a fall directed us to the diagnostic of delayed diaphragmatic rupture. The patient was operated in emergency and post-operative follow-up was simple. Traumatic diaphragmatic hernias are rarely diagnosed directly after trauma. Complications such as pneumonia, occlusion, enteric ischemia, visceral perforation and twisting of splenic hilium can occur many years after the trauma. This is why, for patients with intestinal obstruction or association of pulmonary abdominal symptoms and history of thoraco-abdominal injury, the diagnostic of diaphragmatic hernia should be considered. When patients present complications, there is a higher rate of morbidity and mortality (31%) reason why, emergency surgery is mandatory.

Treatment of Chronic Traumatic Diaphragmatic Hernia Based on Laparoscopic Repair: Experiences From 23 Cases

“…About 90% diaphragmatic hernia occur on the left side, while the right diaphragm is usually protected by the liver with a small chance of TDH (5,(11)(12)(13). Our data were in line with these literatures.…”

“…Compared with laparotomy and thoracotomy, laparoscopic repair is superior in treating CTDH as it involves minimally invasive procedures, including less trauma, faster recovery, and shorter hospital stay (5). Compared with thoracoscopic surgery, laparoscopy contributed to the complete exploration of the entire abdominal cavity, which could illustrate the presence of adverse events such as hemorrhage and gastrointestinal rupture (19).…”

“…Abdominal organs herniated into the chest cavity would lead to clinical symptoms of different systems including chest symptoms (e.g., chest pain, tightness, shortness of breath, and dyspnea), abdominal symptoms (e.g., abdominal pain, nausea, vomiting, stop flatus and defecation, and other manifestations of intestinal obstruction, acid reflux, and belching), as well as the symptoms (e.g., chronic anemia). In cases of strangulation and necrosis in herniate organs, there might be signs of peritonitis, which is a great threat to the life of patients (4,5).…”

“…Diaphragmatic hernia patients with no spontaneous remission are suggested to undergo surgery upon diagnosis (4,6,7). To date, its treatment is highly relied on transthoracic, transabdominal and thoracoabdominal approaches (4,5,8,9). However, there are disputes on the efficiency of these treatment options.…”

Surgical management of delayed-presentation diaphragm hernia: A single-institution experience

“… 14 , 15 Even so, there is some hesitation among surgeons to embrace this due to concern for injury to hernia contents, inability to reduce the hernia, and difficult angles for patch or mesh suturing. 16 This study reports our single-center experience with the repair of delayed-presentation diaphragm hernias using minimally invasive and open techniques.…”