Abstract
A delayed traumatic incarcerated diaphragmatic hernia is rare ; only 23 cases have been reported in Japan to date. A 31-year-old man complained of severe epigastralgia following an episode of vomiting. He had a history of multiple trauma caused by a traffic accident 5 years ago. Since there were no signs of peritonitis, NPO was instituted, and he was given an H2-blocker. Upper GI series and endoscopy showed an abnormally shaped stomach and poor flow of contrast media. Exploratory laparoscopy revealed a prolapse of the stomach into the thoracic cavity via the left diaphragm. The diagnosis of traumatic diaphragmatic hernia was confirmed, and the operation was converted to a laparotomy. The stomach was pulled back into the abdominal cavity, and the abnormal hiatus was closed. In retrospect, the patient noted that since the traffic accident he often had postprandial epigastralgia. In this patient, the stomach might have prolapsed slightly to the left diaphragm due to the accident. An elevation of intra-abdominal pressure caused by vomiting likely worsened the prolapse of the stomach.
