Diaphragmatic rupture with right colon and small intestine herniation after blunt trauma: a case report

Abstract

IntroductionTraumatic diaphragmatic hernias are an unusual presentation of trauma, and are observed in about 10% of diaphragmatic injuries. The diagnosis is often missed because of non-specific clinical signs, and the absence of additional intra-abdominal and thoracic injuries.Case presentationWe report a case of a 59-year-old Italian man hospitalized for abdominal pain and vomiting. His medical history included a blunt trauma seven years previously. A chest X-ray showed right diaphragm elevation, and computed tomography revealed that the greater omentum, a portion of the colon and the small intestine had been transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy, at which time the colon and small intestine were reduced back into the abdomen and the diaphragm was repaired.ConclusionsThis was a unusual case of traumatic right-sided diaphragmatic hernia. Diaphragmatic ruptures may be revealed many years after the initial trauma. The suspicion of diaphragmatic rupture in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only curative treatment for diaphragmatic hernias. Prosthetic patches may be a good solution when the diaphragmatic defect is severe and too large for primary closure, whereas primary repair remains the gold standard for the closure of small to moderate sized diaphragmatic defects.

A case of obturator hernia leading to right thigh abscess in China

“…Hernia contents included the small intestine, colon, omentum, uterus and accessories [12]. The disease of Howship Romberg is the most characteristic signs [13]. Thus, any delay in a diagnosis may lead to necrosis and perforation of the small bowel or a concomitant thigh abscess.…”

Delayed Traumatic Diaphragm Hernia after Thoracolumbar Fracture in a Patient with Ankylosing Spondylitis

“…The audible bowel sounds on the chest auscultation suggest displaced bowel loops. Although the chest X-ray is the first line of investigation and sequential imaging increases sensitivity, with a finding of unusual gas shadow in the lower chest due to a portion of the colon and the small intestine being transposed into the right hemithorax, additional radiologic studies such as CT scan should be required to rule out the fatal injuries 9 , 13) . Nevertheless, a high index of suspicion is the most important tool for proper diagnosis 8) .…”

Rotura diafragmática no trauma abdominal fechado

“…Esta herniação tardia e progressiva resulta em dor abdominal e/ou torácica crônica, constipação, estrangulamento ou perfuração de víscera abdominal, dispnéia, infecção respiratória devido à compressão pulmonar no lado afetado. 17,18 Pacientes com trauma abdominal prévio e sinais de obstrução intestinal devem ser avaliados para a presença de lesão diafragmática não diagnosticada. 16 Outra complicação descrita é a paralisia do diafragma que apesar de ser mais frequente em lesão cervical pode ocorrer em traumas tóraco-abdominais e no procedimento cirúrgico para o reparo do diafragma.…”