Delayed Traumatic Incarcerated Diaphragmatic Hernia That Developed 18 Years After Injury

Case Report with a Review of the Literature in Japan

Abstract

An 82-year-old man was admitted to our hospital for the treatment of skin ulcers and osteomyelitis. While hospitalized, he developed abdominal distension and dyspnea. Clinical examination led to the diagnosis of strangulated bowel obstruction due to a right diaphragmatic hernia, and emergency surgery was performed. As the patient gave a history of right traumatic hemopneumothorax and multiple rib fractures and liver injury resulting from a fall 18 years previously, he was considered as having traumatic diaphragmatic hernia. Intraoperative exploration revealed incarceration of the transverse colon in the thoracic cavity following herniation through the defect in the diaphragm. The incarcerated bowel was retracted into the abdominal cavity and the necrotic segment was resected, followed by end-to-end intestinal anastomosis two days later. Postoperatively, the patient developed complications such as pneumonia and wound dehiscence, and the treatment time was prolonged. Because traumatic diaphragmatic hernia can develop late after injury, a detailed history of trauma and risk factors must be obtained. In addition, early intervention is important because organ resection may be required.