2020 Volume 40 Issue 1 Pages 73-77
An 82–year–old man presented with bruising all over the body after a fall. Computed tomography (CT) revealed left diaphragmatic rupture and prolapse of the stomach and transverse colon into the thoracic cavity. We made the diagnosis of traumatic diaphragmatic hernia, and immediately performed thoraco– and laparoscopic repair of the hernia. The operation was performed with the patient in the semi–right lateral decubitus position, and the hernia of the intra–abdominal organs was reduced laparoscopically. Thoracoscopy revealed no injury of the lung or mediastinum. A horizontal rupture of the diaphragm measuring 8cm in length was noted in the left central tendon; the defect was sutured laparoscopically. The operative diagnosis was traumatic diaphragmatic hernia, typeⅢb, according to the criteria of the Japanese Association for the Surgery of Trauma. A repeat CT performed on postoperative day 11 revealed increased pericardial fluid accumulation and recurrence of the diaphragmatic hernia. Reoperation (thoracoscopic repair using a mesh) was performed on postoperative day 75. Until now, 12 months after the reoperation, there has been no further evidence of recurrence. The thoracoscopic approach might be the preferred approach for surgical repair of traumatic diaphragmatic hernias occurring adjacent to the pericardium.
