Delayed Presentation of Traumatic Right-Sided Diaphragmatic Hernia after Abdominoplasty

Abstract

Traumatic diaphragmatic hernias are rare and challenging to diagnose. Following trauma, diagnosis may occur immediately or in a delayed fashion. It is believed that left traumatic diaphragmatic hernias are more common as a result of the protective right-sided anatomic lie of the liver. If unrecognized, traumatic diaphragmatic injuries are subject to enlarge over time as a result of the normal pressure changes observed between the thoracic and abdominal cavities. Additionally, abrupt changes to the pressure gradients, such as those which occur with positive pressure ventilation or surgical manipulation of the abdominal wall, can act as a nidus for making an asymptomatic hernia symptomatic. We report our experience with a delayed traumatic right-sided diaphragmatic hernia presenting with large bowel incarceration two months after abdominoplasty. In our review of the literature, we were unable to find any reports of delayed presentation of a traumatic right-sided diaphragmatic hernia occurring acutely following abdominoplasty.

Resolution of Chronic Shoulder Pain after Repair of a Posttraumatic Diaphragmatic Hernia: A 22-Year Delay in Diagnosis and Treatment

“…Stable patients can be managed with laparoscopy, thoracoscopy, or video-assisted thoracoscopic surgery (VATS). Smaller diaphragmatic ruptures can be primarily repaired (as done in our patient), while larger defects may require incorporation of a mesh [32,33]. Our patient's left shoulder and mandibular pain immediately and completely resolved following repair of the diaphragm, supporting our conclusion that these symptoms were caused by diaphragmatic irritation rather than intrinsic shoulder pathology.…”

Delayed hepatothorax: An unusual presentation case report

“…The main principles of hepatothorax repair due to traumatic diaphragmatic hernia include decompression, reducing the hernia back into the abdominal cavity, and ensuring secure closure of the diaphragmatic defect [3] . Although the type of closure used for diaphragmatic hernias is still a matter of debate, it is generally accepted that most defects can be closed primarily with nonabsorbable sutures [12] . This is because, during closure of the diaphragm, as much as a 100 cm H 2 O pleuroperitoneal pressure gradient may occur during inspiration, which may pull apart a diaphragmatic repair and thereby force intraabdominal contents into the chest [13] .…”

Post-Traumatic Diaphragmatic Hernia -Delayed Presentation with Complications

“…This is because most hernias are small in the early stages, but the size increases with passage of time due to herniation caused by thoracic and abdominal cavity pressure differences. [2] The force vectors that develop during the impact, change the pattern of diaphragmatic rupture. Lateral impacts cause an anteroposterior elongation of the thoracic cage with subsequent rupture of the diaphragm or detachment of its insertions, whereas there is an abrupt increase in the intraabdominal pressure in the frontal impacts, transmitting the impact to the pillars of the diaphragm and its rupture.…”