Delayed Presentation of Right-sided Traumatic Diaphragmatic Hernia

ABSTRACT

The diaphragmatic injury is often associated with thoracic or abdominal trauma. This injury has wide spectrum of symptoms from minimal discomfort to strangulation of the herniated organ. Herein we report a case of delayed presentation of traumatic diaphragmatic hernia treated surgically. The case was discovered about five years later after fall down accident. The patient complained intermittent chest discomfort and pain at the first visit of our department. On physical examination, slightly decreased breathing sound was noted in right lower lung field. The thoracic CT and MRI findings were suggestive of right side diaphragmatic injury with herniation of liver. Under general anesthesia, we confirmed diaphragmatic hernia through thoracoscopic evaluation of right thorax. Unfortunately it was too hard to put liver back into peritoneal cavity through the thoracoscopic procedures. Then we performed abdominal laparotomy and the herniated liver was reduced. The patient was tolerated well and recovered without complications.