2018 Volume 38 Issue 3 Pages 583-586
A 74-year-old woman visited another orthopedics hospital after falling over at home and was diagnosed as having a fractured right rib. The patient was instructed to rest at home with conservative treatment, but experienced gradual decline in her activities of daily living. Eighteen days after the fall, she was readmitted to the orthopedics hospital with difficulty in breathing. She underwent chest radiography, which revealed several abnormalities and was thus referred to the emergency department of our hospital, where she was diagnosed, based on chest X-ray findings, as having pleural effusion, blunt lung trauma, abnormal intestinal gas in the right intrathoracic area and left-sided deviation of the trachea. Computed tomography showed herniation of the small intestine into the right thoracic cavity. The patient was diagnosed as having a right traumatic diaphragmatic hernia and an immediate operation was performed. We found a 4-cm long tear in the right diaphragm. The small intestine was pulled back intraperitoneally and the diaphragmatic tear was sutured. She finally recovered and was discharged on the fifteenth hospital day.
