Successful Surgical Outcome after Traumatic Diaphragmatic Intra-Pericardial Herniation from Blunt Abdominal Injury

Abstract

Intrapericardial diaphragmatic hernia (IPDH) is a rare manifestation of non-hiatal diaphragmatic hernias (NHDH). Intrapericardial diaphragmatic hernia is defined as the prolapse of the abdominal viscera into the pericardium through the diaphragm. Their incidence has increased over the last 50-60 years, secondary to high-speed transport, and constitutes 5% of major thoracic and abdominal trauma today. These injuries can present during the initial workup or months after the initiating injury. These hernias can be caused by both blunt and penetrating trauma with concomitant central tendon rupture and pericardial laceration. We report an interesting case of intrapericardial diaphragmatic hernia with delayed presentation that was successfully reduced via open surgical repair after a laparoscopic repair attempt failed. We present a 77-year-old female admitted to the hospital after a motor vehicle crash. On hospital day 9, the patient developed shortness of breath, which prompted a chest x-ray. The chest x-ray revealed bowel in the patient’s chest. The patient was taken to the operating room, where they underwent an attempted laparoscopic diaphragmatic hernia repair and, ultimately, open repair of the diaphragmatic hernia. The patient did well after surgery and was discharged on post-injury day 22.