Traumatic intrapericardial diaphragmatic hernia

This article describes the case of a 33-year-old male who sustained blunt trauma to his torso in a high-speed motor vehicle accident. He presented to the emergency room with abdominal pain, chest pain, dyspnea, distended neck veins, and shock. There was no history of pretraumatic chest symptoms or congenital abnormalities. Computed tomography (CT) of the chest showed bowel loops extending into the pericardium through a large rent in the diaphragm. A diagnosis of traumatic intrapericardial diaphragmatic hernia (TIPDH) was made. Hence, the patient was transferred to the theater where surgical mesh repair was done through an open laparotomy. TIPDHs are rare, forming about 0.9% of traumatic diaphragmatic hernias with only 96 cases reported in worldwide literature as at 2014. However, they are potentially life-threatening and require a high index of suspicion to diagnose. They often result from blunt abdominal trauma. Symptoms include chest pain, abdominal pain, and dyspnea, with or without features of cardiac tamponade or bowel obstruction. CT scan is the best diagnostic tool. Primary repair through open laparotomy is recommended in acute cases, with mesh reinforcement for large diaphragmatic tears to ensure the repair is tension-free.