Traumatic Diaphragmatic Rupture With Pericardial Tear and Transdiaphragmatic Herniation of the Stomach

Abstract

Traumatic diaphragmatic rupture is uncommon in blunt or penetrating abdominal trauma. Diaphragmatic injury associated with pericardial tear is even rarer. Here, we report a case of a 23-year-old female who presented with complaints of chest pain, abdomen pain, and breathlessness following blunt trauma abdomen. An imaging study showed the presence of transdiaphragmatic herniation of the stomach inside the thorax. Emergency exploratory laparotomy was done, and we found a large diaphragmatic defect with a pericardial tear with herniation of the stomach. Both diaphragmatic and pericardial tears were repaired primarily. Postoperatively, the patient improved well without any complications.

Case Report: Surgical challenges and insights in a child with a blunt left diaphragmatic and pericardial rupture and heart subluxation

“…A traumatic diaphragmatic rupture is the loss of integrity of the diaphragm due to a sudden increase in intra-abdominal pressure from trauma ( 10 – 12 ). The most common site of rupture is at the junction of the muscle and tendon ( 3 ).…”

“…Although injury to different organs is commonly associated with BTDR, a pericardial tear is very rare and is associated with a high mortality rate reaching up to 64% ( 4 , 11 ). An isolated pericardial tear in a patient with BTDR is even rarer ( 12 ). However, the patient in this study presented with an isolated pericardial rupture with BTDR.…”

“…However, the patient in this study presented with an isolated pericardial rupture with BTDR. Following blunt trauma, most pericardial ruptures occur in the left pleuropericardial region ( 12 ). Pericardial rupture is an elusive diagnosis, with most cases identified intraoperatively ( 5 , 6 ).…”

“…Most patients with pericardial rupture are asymptomatic and show signs and symptoms only when there is an associated herniation of the heart or when bleeding occurs ( 5 ). Large defects in the pericardium can result in dislocation or torsion of the heart ( 12 ). In our patient, there was a subluxation of the cardiac apex on the right side and the defect was closed, with herniated abdominal viscera preventing displacement of the heart out of the pericardial space through the defect.…”

Comparative Review of Computed Tomography Scans and Radiography in Evaluating Blunt Chest Trauma

“…25 (Figure 2) Interpreting radiographic indications of blunt diaphragmatic injury requires careful consideration, and their interpretation should be aligned with CT scan findings. 26 Possible radiographic indicators encompass elevation of the affected hemidiaphragm, the "cottage bread" phenomenon illustrating abdominal organ herniation through the diaphragmatic breach, or even the direct protrusion of abdominal structures into the corresponding hemithorax. 27 The "cottage bread" sign entails abdominal contents assuming a brioche-like appearance upon herniation through the diaphragmatic opening.…”