Trauma-Induced Delayed Presentation of Diaphragmatic Hernia with Gastric Volvulus: A Rare Presentation.

Abstract

A 19-year-old male presented with a three-day history of worsening epigastric pain, persistent vomiting, abdominal distension, and obstipation. His medical history included high-fall trauma in 2022, resulting in a parietal bone fracture, scalp swelling, and an epidural hematoma. Physical examination revealed epigastric tenderness, abdominal distension, and diminished bowel sounds. Imaging revealed a 7 cm left diaphragmatic defect with herniation of the stomach, colon, and mesentery into the thoracic cavity, confirming a diagnosis of gastric volvulus with a diaphragmatic hernia. An exploratory laparotomy confirmed herniation of the stomach, transverse colon, spleen, and pancreas. The procedure involved derotation of the gastric volvulus, reduction of the herniated organs, and repair of the diaphragmatic tear; a fundoplication was also performed to prevent recurrence. The patient's recovery was uneventful, and he was discharged on the fifth postoperative day. He remained asymptomatic at the six-month follow-up. This case underscored the importance of considering gastric volvulus and diaphragmatic hernia in trauma patients presenting with gastrointestinal symptoms, highlighting the necessity of early diagnosis and prompt surgical intervention.