Right-sided diaphragmatic rupture after trauma—hepatothorax: a diagnostic challenge

Q4 Medicine

Trauma Case Reports Pub Date : 2025-05-27 DOI:10.1016/j.tcr.2025.101191

Guruprasad Rai , Rajkamal Vishnu , Vijaya Kumara , Ganesh Sevagur Kamath

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引用次数: 0

Abstract

Background

Traumatic diaphragmatic rupture is an uncommon condition. Furthermore, due to the shielding effect of the liver, right-sided ruptures occur less frequently than left-sided ones.

We report two unusual cases of right-sided diaphragmatic rupture due to trauma and describe our experience to aid medical professionals in their diagnosis and management.

Purpose

This report focuses on two atypical cases of right-sided traumatic diaphragmatic rupture causing herniation of the liver into the right thorax, a rare condition, and this provides insights for healthcare professionals regarding diagnosis and management.

Case

We present two case reports involving male patients aged 64 and 56 who sustained right-sided diaphragmatic ruptures due to blunt trauma mechanisms—a motorcycle accident and a similar road traffic accident, respectively. Clinical examinations and imaging studies revealed hemothorax and elevated right dome of the diaphragm in Case 1 and pneumoperitoneum and multiple fractured ribs with elevated right dome of diaphragm and minimal hemothorax in Case 2. Surgical interventions were conducted for both patients; Case 1 confirmed a right diaphragmatic rupture with liver herniation, which was successfully repaired, and Case 2 surgical intervention revealed a large right-sided diaphragmatic tear, with liver herniating into the thorax. A successful reduction of the liver and closure of the defect were performed.

Conclusion

Diaphragmatic rupture should be considered as a differential in patients involved in any abdominal trauma, specifically on the right side, as the presentation is often subtle. Chest x-ray and computed tomography are essential tools to confirm the diagnosis. Surgical repair of the defect is the standard treatment.

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外伤性肝胸后右侧膈破裂：一个诊断挑战

背景外伤性膈破裂是一种罕见的疾病。此外，由于肝脏的屏蔽作用，右侧破裂的发生率低于左侧。我们报告两个不寻常的病例右膈破裂由于创伤和描述我们的经验，以帮助医疗专业人员在他们的诊断和管理。目的：本文报道两例非典型右侧外伤性横膈膜破裂导致肝脏疝入右胸的罕见病例，为医疗保健专业人员提供诊断和治疗方面的见解。我们报告了两例男性患者，年龄分别为64岁和56岁，分别因摩托车事故和类似的道路交通事故造成右侧膈肌破裂。临床检查和影像学检查显示病例1为血胸和右侧膈球升高，病例2为气腹和多发肋骨骨折，右侧膈球升高，少量血胸。两例患者均行手术干预；病例1证实右侧膈破裂伴肝疝，并成功修复，病例2手术发现右侧膈大撕裂，肝疝入胸腔。我们成功地复位了肝脏并闭合了缺损。结论膈破裂应被视为腹部创伤患者的鉴别指标，尤其是右侧腹部创伤，因为其表现通常很微妙。胸部x光和计算机断层扫描是确认诊断的基本工具。手术修复是标准的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Trauma Case Reports Medicine-Emergency Medicine

CiteScore

0.60

自引率

0.00%

发文量

131

审稿时长

26 weeks

期刊介绍： Trauma Case Reports is the only open access, online journal dedicated to the publication of case reports in all aspects of trauma care and accident surgery. Case reports on all aspects of trauma management, surgical procedures for all tissues, resuscitation, anaesthesia and trauma and tissue healing will be considered for publication by the international editorial team and will be subject to peer review. Bringing together these cases from an international authorship will shed light on surgical problems and help in their effective resolution.