Right sided traumatic diaphragmatic hernia repair with intrathoracic herniation of liver, stomach and transverse colon

Abstract

Traumatic rupture of the right dome of the diaphragm is an uncommon clinical entity. The diagnosis is difficult due to lack of specificity in clinical signs and chest film findings. Clinical incidence of rupture of the right dome of the diaphragm due to blunt trauma is much less common (10%) compared to the left (90%) and usually associated with more grievous injuries with very high pre hospital mortality thus accounting for rare clinical diagnosis. We report a case of 26 year old male who had the blunt trauma chest referred to us after 7 days of injury with complaints of shortness of breath and vomiting. On investigations the patient was diagnosed as a case of the ruptured right dome of the diaphragm with intrathoracic herniation of the stomach. The patient also had fracture pelvis. Surgical exploration was done through right 6th intercostal space which revealed intrathoracic herniation of the stomach, liver and transverse colon, which were healthy. Contents reduced into the abdomen and diaphragm was repaired. Post operative chest X-ray suggested complete expansion of the right lung with no residual herniation of abdominal contents. Post operative recovery was uneventful with the patient discharged on 14th post operative day.

Incidental traumatic right diaphragmatic rupture: a missed case after trauma

“…Most cases of diaphragmatic rupture occur on the left side (75%), with the spleen being the most common injured organ [5]. Due to the cushioning effect of the liver on the right side, injuries to the right diaphragm are less traumatic, which is why right diaphragmatic rupture is less common [6]. Nevertheless, an increase in the number of reported cases of right diaphragmatic rupture has been noticed, mostly due to the improvement of posttrauma investigations and high clinical suspicion [5].…”

Intra-thoracic Symptomatic Gallstones in a Right-Sided Post-traumatic Diaphragmatic Hernia: A Case Report

“…The right side is involved in 10% of patients. In comparison, the left-side dome is involved in 90% of cases after injury and carries a high mortality rate due to damage to the heart and other vital organs lying in the left abdominal and thoracic cavity [ 8 ]. The protective effect of less injury on the right side is owed to the presence of the liver on the right side, which acts as a shock absorber during trauma, preventing damage to the diaphragm's right dome.…”