Colobronchial Fistula Complicating a Traumatic Right Diaphragmatic Hernia: A Case Report

Abstract

The delayed presentation of traumatic diaphragmatic hernia is associated with high morbidity and mortality. Acute colobronchial fistula complicating delayed presentation of traumatic diaphragmatic hernia is previously unreported. A 52-year-old woman presented with a 4-day history of dyspnoea, feculent sputum and chest and abdominal pain 3 months after a road traffic accident. The diagnosis of Chilaiditi's syndrome, diaphragmatic hernia and colobronchial fistula was confirmed with computed tomography (CT) and treated by chest drain, primary hernia repair and right hemicolectomy. Spontaneous decompression through the bronchus had prevented tension fecopneumathorax. The diagnosis of diaphragmatic hernia is difficult but delay is associated with increased mortality. Symptoms include dyspnoea, chest and abdominal pain, with decreased respiratory sounds and visceral sounds in the thorax. Abdominal visceral structures or gas on CXR, CT or contrast studies will confirm the diagnosis. The initial operative approach is laparotomy but thoracotomy must be considered as abdominal viscera may be adherent to thoracic structures.

Colobronchial fistula: the pathogenesis, clinical presentations, diagnosis and treatment

“…Based on the anatomical location of fistula and different causes, all the CBF cases were classified into four different types. Type I, CBF secondary to the adhesion among colon, diaphragm and lung (20 cases) (1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(19)(20)(21)(22)29): both the colon and lung directly adhere to diaphragm and the fistula forms between colon and lung through diaphragm; type II, CBF secondary to diaphragmatic hernia (8 cases) (2,3,17,18,23,24): the colon goes through diaphragm to form diaphragmatic hernia, directly adheres to lung tissue and forms fistula; type III, CBF secondary to sub diaphragmatic abscess or empyema (7 cases) (4,5,(25)(26)(27)(28)30): the colon and lung tissue fistula connect indirectly through the sub diaphragmatic or pleural abscess; type VI, CBF secondary to colon interposition (2 cases, Figure 2) (31,32).…”

“…For type IV, all 2 cases accepted colonic interposition ( Table 1). There were 30 cases (2,4,(6)(7)(8)(9)(10)(12)(13)(14)16,17,(19)(20)(21)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) with the left side fistula and 7 cases (1,3,5,11,15,18,22) with the right side fistula.…”