Complicated chronic traumatic diaphragmatic hernia

Abstract text (incl. references and figure legends)

CASE HISTORY

75-year-old male with a previous history of blunt abdominal trauma 30 years past arrived at the Emergency Department presenting with five days of abdominal pain, vomiting and constipation

CLINICAL FINDINGS

HD stable

PE: distended and tympanic abdomen, with tenderness and palpation of an abdominal mass in the right upper quadrant without signs of peritoneal irritation

RESULTS AND FINDINGS

Laboratory tests: leuokocytosis of 16000 x10E3/microL (4.0 - 11.5). Normal coagulation profile

CT Scan: right anterolateral diaphragmatic hernia with incarcerated right colon (Figure 1)

THERAPY AND PROGRESSIONS

Urgent laparotomy:

Findings: right anterolateral diaphragmatic post-traumatic hernia with a 4 cm breach, containing deseroused and aperistaltic herniated right colon (Figure 2)

Technique: right hemicolectomy with ileotransverse L-L anastomosis, diaphragmatic hernia reparation with non-absorbable suture and chest tube placement Acute respiratory distress requiring long term hospitalization–ICU

COMMENTS

Traumatic diaphragmatic injuries encompass less than 1% of trauma associated lesions¹ Up to 60% develop unnoticed. Delayed diagnosis is associated with higher morbidity and mortality rates² Blunt trauma leads to large rents in the diaphragm, most frequently the left hemidiaphragm³, unlike our case; and is more likely than penetrating trauma to lead to herniation of abdominal contents, most commonly the stomach and colon, into the chest Once the diagnosis is made, operation is mandatory

REFERENCES

Fair KA, et al. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg. 2015 May;209(5):864-8 2. Zarour AM, et al. Presentations and outcomes in patients with traumatic diaphragmatic injury: a 15-year experience. J Trauma Acute Care Surg. 2013 Jun;74(6):1392-8 3. Tan KK, et al. Management of diaphragmatic rupture from blunt trauma. Singapore Med J. 2009 Dec;50(12):1150-3

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