Laparoscopic repair of a traumatic right diaphragmatic hernia

Abstract text (incl. references and figure legends)

INTRODUCTION: Blunt diaphragmatic injury has been increasing and frequently is associated with considerable comorbidity. This injury is often missed at the time of the initial event. Some studies indicate that 2,7% to 50% of diaphragmatic ruptures may not be diagnosed initially. The development of imaging techniques, in particular computed tomography, have increased the rate of early diagnosis. Some ruptures only can be seen later because an unidentified rupture can enlarge when intra-abdominal pressure rises. Therefore, we can classify the diaphragmatic hernias in acute or chronic. The definition of chronic diaphragmatic hernia is controversial. Some authors use a specific time such as 1 month as a cutoff for acute. Left-sided hernias are more common than right-sided.

METHODS: Presenting a case report.

RESULTS: Female patient, 33 years old. She was admitted to the emergency department after a fall from height, which resulted in thoracic, abdominal and vertebral trauma. The thoracic imaging study revealed rib fratures with bilateral pneumothorax. She underwent bilateral chest drainage and was admitted to intensive care. On the 13th day of hospitalization due to failure to resolve the pneumothorax on the right side, an imaging study with tomography (CT) and bronchoscopy was done. Bronchoscopy excluded bronchopleural fistula. CT scan revealed extensive diaphragmatic rupture with hepatic herniation. The patient was proposed for laparoscopic correction of the hernia. The defect was closed with primary repair and a mesh. The surgery and the postoperative period went uneventfully. Prior to discharge, she underwent imaging reassessment with CT that revealed complete lung expansion and resolution of the pneumothorax. She was discharged home asymptomatic.

CONCLUSIONS: Improved awareness of diaphragmatic injuries will increase the rate of early diagnosis and improve prognosis. The laparoscopic approach is safe and less aggressive for the patient.

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