Delayed presentation of blunt traumatic diaphragmatic hernia: A case report

Abstract

Blunt traumatic diaphragmatic rupture is an uncommon but severe problem that is usually seen in polytraumatized patients. Diagnosis is often difficult resulting in delayed presentation and increased morbidity. We report a case of blunt traumatic diaphragmatic hernia in a 39-year-old man presenting 10 years after the initial abdomino-thoracic injury sustained in a road traffic accident. He had herniation of the spleen and stomach. Through a left thoracotomy, the herniated organs were reduced and diaphragmatic defect closed with interrupted nylon sutures. A high index of suspicion would minimize the morbidity and mortality associated with delayed diagnosis.

Delayed Presentation of Posttraumatic Diaphragmatic Hernia Masquerading as Recurrent Acute Asthmatic Attack

“…Other plain radiograph findings that may suggest possibility of diaphragmatic rupture include abnormalities such as multiple lower rib fractures, haemothorax, and pneumoperitoneum [ 11 ]. Occasionally, there may be initial misdiagnosis on chest X-ray necessitating further investigations [ 2 ].…”

“…Our patient had herniation of the transverse colon on barium enema investigation. Others include upper gastrointestinal contrast studies, diagnostic peritoneal lavage, fluoroscopy, ultrasound, magnetic resonance imaging, laparoscopy, and intraperitoneal injection of radioisotopes [ 11 ].…”

“…Acute cases are better managed via a laparotomy as this also rules out and treats associated intra-abdominal organ injuries. Delayed cases, however, are better treated via a thoracotomy or thoracoabdominal approach because of intrathoracic adhesions [ 2 , 11 ]. Our patient was operated on via laparotomy; however no adhesion was encountered between the herniated organs and the lungs despite presenting after 2 years of the blunt abdominal injury.…”

“…Our patient was operated on via laparotomy; however no adhesion was encountered between the herniated organs and the lungs despite presenting after 2 years of the blunt abdominal injury. Repair of diaphragmatic defect is usually achieved with interrupted nonabsorbable sutures like nylon and Prolene in a single or double-layered fashion [ 11 ]. Mesh repair is used for large defect [ 11 ].…”

“…Repair of diaphragmatic defect is usually achieved with interrupted nonabsorbable sutures like nylon and Prolene in a single or double-layered fashion [ 11 ]. Mesh repair is used for large defect [ 11 ].…”