Traumatic diaphragmatic hernia presenting as gastric outlet obstruction: A delayed presentation.

Abstract

Abstract: Traumatic diaphragmatic hernia (TDH) is a rare acquired condition usually occurring due to blunt thoracoabdominal trauma, most commonly in road traffic accidents (RTAs). It may also occur due to penetrating trauma. Diagnosis may be delayed due to the masking effect of other severe injuries in a patient with polytrauma. Here, we present the case of a 23-year-old male patient having a history of thoracoabdominal injury due to RTA before 3 months, presenting with severe vomiting, respiratory discomfort and weight loss. He was treated at other places symptomatically for gastritis and flatulence. He was diagnosed with gastric outlet obstruction due to left-sided TDH. He was successfully treated with laparoscopic repair and mesh placement. He needed thoracotomy for left lung decortication in post-operative period owing to persistent pleural effusion and lung collapse. He recovered well and remains asymptomatic on follow-up. Upon asking detailed history, he remembered that he had trauma following being struck by a vehicle. We aim to present this case to highlight the importance of detailed history taking for arriving at a timely diagnosis.