Asymptomatic Traumatic Hepatothorax, Symptomatic Gall Stone Disease – A Rare Coincidence

Abstract

Traumatic diaphragmatic hernia rarely affects right side due to protective effect of liver. In adult it is mainly caused by blunt abdominal trauma. Acute presentations are often life threatening and usually clinch the diagnosis early. It may remain asymptomatic for many years unless being detected incidentally during investigations for some unrelated reason or getting complicated by some pathology of herniated viscera. High degree of suspicion is required to detect this delayed presentation particularly in a post-trauma patient as this condition may require modifications in management. We report a case of acute cholecystitis which revealed a rare association of traumatic right diaphragmatic hernia and hepatothorax.

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

“…Similar cases of right-sided diaphragmatic hernias were reported by Das et al [9], in which a 62-year-old male presented with combined pathology of acute cholecystitis and intrathoracic gallbladder along with a right-sided post-traumatic diaphragmatic hernia. History revealed that the cause of diaphragmatic hernia was a high-speed motor vehicle injury 24 years ago, resulting in spinal cord injury and weakness of both lower limbs later in life, presented with acute cholecystitis in the intrathoracic gallbladder.…”

“…But the mortality on the right side is even greater than left-sided injury because the injury required to cause rupture of the right diaphragm is enormous and damages the liver, pancreas, and intestine as well as pelvic organs making high mortality rates after right-sided diaphragm injury. If survived, it remains silent for a long duration and becomes evident incidentally during imaging for any other etiology or presents with complications of herniated abdominal viscera [ 9 ]. Usual presenting complaints include respiratory distress and non-responding cough, which is mistaken as recurrent pneumonia and being treated with excessive antibiotics.…”

“…Still, no improvement in symptoms leads to extensive workup, and underlying pathology of diaphragmatic hernia is revealed, followed up with a referral to the surgeons. While some patients may present to surgical emergency with signs and symptoms of intestinal obstruction and workup for laparotomy reveals underlying diaphragmatic hernia on chest X-ray or ultrasound abdomen [ 9 ].…”

Post-Traumatic Right Diaphragmatic Hernia with Hepatothorax

“…Herniation of the right side of the diaphragm is an extremely rare condition owing to protection by the liver. Acute presentation is often life-threatening and early diagnosis is critical [4] [5]. Open Journal of Thoracic Surgery Diaphragmatic hernia can also be caused by a defect in the diaphragm and is divided into congenital and acquired forms, where the latter may be confounded with Morgagni hernia.…”