Blunt Traumatic Diaphragmatic Hernia: Case Report

Case Report A 55-year old man visited the orthopedic OPD due to tenderness and swelling at left ankle from a motorcycle accident, 3 hours before. Left medial malleolus fracture was diagnosed. A short leg cast was performed by orthopedist. During the wait to receive his medicines, he had sudden onset of chest discomfort, pain at left lower chest and left upper abdomen. He was sent to the ER department. He had blood pressure of 110/75 mmHg, pulse rate of 64 beats/min, respiratory rate of 20 breaths/min and oxygen saturation of 97%. A physical examination found mild pale conjunctiva, tender at left chest wall, equal breath sounds. Mild tenderness at LUQ was also noted without guarding or rebound tenderness. Chest film showed air-fluid level within left hemithorax and mild shifting of mediastinum to the right. A CT chest including upper abdomen with contrast study was performed. Discontinuity of left hemidiaphargm with herniation of stomach and duodenum into left hemithorax was seen. Splenic laceration and minimal left hemothorax were also noted. He was admitted at the traumatic surgery ward for an exploratory laparotomy. Rupture of left hemidiaphragm, approximately 10 cm in diameter, with herniation of stomach, duodenum and omentum into left thorax was found. Left hemothorax and splenic contusion were also found. Repair to left diaphragm with interrupted non-absorptable sutures was performed. No evidence of complication was detected.