An unusual diaphragmatic hernia with gastric perforation and sub-acute presentation

Abstract

Gastric perforation into the thoracic cavity through a diaphragmatic hernia is rare but, when it occurs, patients present in severe distress, with mortality approaching 50%. We present a unique case in which a fibrotic reaction between the stomach and the parietal pleura led to a subacute presentation upon perforation. The extra time that this afforded led to more effective multidisciplinary team management and ultimately an excellent outcome for the patient.

The rare and unusual presentation of a gastric perforation in the setting of a large diaphragmatic hernia: a case report and literature review

“…Much of the delayed diagnosis can be attributed to the non-specific presentation of some of these patients as in our case as he originally presented with mild right upper quadrant abdominal pain. This is a unique case of an individual with a sub-acute presentation associated with a gastric perforation in a setting of a large diaphragmatic hernia with the lack of serious symptoms, which is consistent with the previous report from Vinnicombe et al [ 4 ]. These are the only two known case reports in literature to report two disease entities occurring simultaneously that can both be associated with high morbidity and mortality if left untreated.…”

“…Our report sheds light on management of a gastric perforation in the setting of a large diaphragmatic hernia in a clinically stable patient. Our findings are consistent with only one other published report [ 4 ], and further investigations are warranted for a better outcome.…”

“…Although it has been ~30 years since our patient fell off a ladder and has been relatively asymptomatic, we cannot exclude this trauma as the inciting cause. The gastric perforation of adult-onset diaphragmatic hernia together with stable clinical status was previously reported by Vinnicombe et al [ 4 ]. Nevertheless, their patient had neither recent nor past history of trauma.…”

Rotura diafragmática traumática con herniación esplénica. Un caso inusual de hemotórax

“…Excluyendo la hernia congénita, la causa más común de hernia diafragmática en los adultos es el trauma, y los mecanismos habituales son los traumas contusos y las lesiones penetrantes 1 . Dentro de la etiología traumática, el hemidiafragma izquierdo es el más afectado, reportándose su frecuencia en un 50% a 80% de los casos; las lesiones de lado derecho oscilan entre el 12% y el 40%, y de forma menos común, la lesión bilateral se presenta solo en un 2% de los casos 2 .…”

Double Blow Injury: Diaphragmatic Rupture with Gastric Perforation Following Blunt Trauma

“…Nevertheless, they have high morbidity and mortality, and hence, prompt resuscitative measures need to be contemplated to save the lives [3]. An added gastric perforation in such a complicated scenario is a lethal double blow injury with only handful of reports [4,5] . The purpose of this article is to sensitize the readers about this rare entity and also discuss the diagnostic dilemma along with potential challenges.…”