Liver in the Chest: A Case of a Large Traumatic Diaphragmatic Rupture

Abstract

Motor vehicle collisions (MVC) cause more than one million deaths annually and an estimated 20-50 million significant injuries. They can cause blunt and penetrating trauma. Blunt diaphragmatic rupture is generally associated with multiple severe injuries due to the high force needed to cause the injury. Traumatic diaphragmatic rupture (TDR) is normally identified during advance trauma life support (ATLS) secondary survey, after other more serious injuries are identified in the primary survey. We present a case of a patient who was involved in a MVC with multiple injuries, which were treated appropriately, prior to identification and treatment of a severe right-sided diaphragm injury. Imaging showed only a persistent right hemidiaphragm elevation. Intra-operative findings consisted of complete herniation of the liver with a Grade IV, 30 cm, right-sided diaphragmatic rupture. The herniated liver was repositioned and the diaphragm primarily repaired without complication. This case highlights a severe injury from a blunt MVC and rapid successful recovery of the patient once appropriately treated.

A diaphragmatic hernia in a traumatic patient simulating a hemorrhage: A case report

“….While there is no consensus on the best surgical approach, some believe that the abdominal approach is more beneficial than the thoracic approach [7] . The minimally invasive approach suggests by some authors if the patient is stable, and TDR is questionable [11] .…”

“… mechanism site Diagnosis Access/approach Morbidity/mortality 1998 1 Blunt Right CT scan Open/abdominal Pleural effusion/none [12] 2009 1 Blunt Right Intraop. Open/abdominal None [1] 2013 21 17 blunt 19 Left CT scan Open/abdominal None [2] 2017 6 1 blunt Left CT/X-ray Open/Both None [5] 2017 1 Blunt Left CT scan Open/abdominal None [13] 2020 1 Penetrating Left CT scan Open/abdominal None [10] 2020 1 Blunt Left CT scan Open/abdominal Pleural effusion/ none [4] 2020 1 Blunt Left CT scan Lap / abdominal None [9] 2021 1 Blunt Right X-ray Open/thoracic None [11] 2022 1 Blunt Left CT scan Open/abdominal None [8] …”