Abstract
The case involved a 59-year-old man who was seriously injured in a traffic accident at the age of 25 years and thereafter had been suffered from paralysis of the lower half of the body. At the age of 35 years, he was pointed out having left diaphragmatic hernia but had not received any treatment for it until 2003 when he was seen at the hospital because of upper abdominal pain. Left traumatic diaphragmatic hernia was diagnosed and the hernia orifice was directly sutured. He had been asymptomatic thereafter. In 2009, he was brought into our hospital by ambulance because of the sudden onset of chest pain and back pain.
Chest X rays showed bowels in the left pleural cavity, and CT scan showed the small intestine which escaped in the left pleural cavity, expansion of the small intestine and recurrence of diaphragmatic hernia.
We diagnosed the case as recurrent diaphragmatic hernia and strangulation ileus and performed emergency surgery. Upon laparotomy we confirmed a new hernia orifice on the outside of the last operation with the dilated small intestines, which had incarcerated in the thoracic cavity. We drew the small intestine necrotized in the range of approximately 150cm in the abdominal cavity, and performed partial excision of the small intestine. The hernia orifice was 3cm in size, but the direct choke was impossible. We closed the hernia orifice by using a flap created from transversus abdominis muscle. We report on our experience with a rare case of recurrence of traumatic diaphlagmatic hernia.
