Traumatic rupture of diaphragm with flail chest mimicking tension hydropneumothorax.

ABSTRACT

Traumatic rupture of diaphragm though not rare, presents as complication of penetrating and blunt injuries of chest and abdomen. Preoperative diagnosis of diaphragmatic injury is difficult because of the complex shape of the thin diaphragmatic muscle, the horizontal in-plane orientation of one diaphragmatic dome, and the often associated traumatic abnormalities in the lung bases. Failure to detect this underlying injury is associated with significant morbidity and mortality because of delayed visceral herniation, strangulation or both. We report a case of left-sided post traumatic rupture of diaphragm presenting as tension hydropneumothroax following a road traffic accident. It was managed as tension hydropneumothorax during initial resuscitation by intercostal tube drainage. Lack of improvement in the clinical condition led to the suspicion of diaphragmatic rupture. The patient was managed successfully by operative repair of diaphragm and manual reduction of hernial contents