A case of delayed diaphragmatic hernia by blunt trauma

Abstract

The patient, a fifty-nine year old female, was hit in the right hypochondorium by a traffic accident and transported to our hospital. The initial chest X-ray and CT scans revealed right multiple rib fractures and traumatic pneumohemothorax. After the chest tube drainage, clinical and radiological findings were improved, but on the next day they were worsened again. Though an additional drainage tube was inserted, her condition did not improve. Operation was performed with a diagnosis of right traumatic pneumohemothorax on the fourth day after the accident. On thoracotomy, the right diaphragm was torn about 10 cm in diameter and the liver was lifted up into the thoracic cavity. After the liver restored, the tear of the diaphragm was sutured. Postoperative course was uneventful. Diaphragmatic hernia by blunt trauma is occasionally seen as one of multiple life-threaten injuries. We should consider the possibility of delayed presentation like our case, and careful observation of the clinical course is needed. The thoracoscope might be helpful in the cases which diaphragmatic hernia is suspected and a radiological diagnosis is difficult to make.