Abstract
An 87-year-old woman presented to our emergency clinic because of a lasting abdominal pain after defecation in September 2012. When she was first seen, she had decreased oxygen saturation index and intermittent severe abdominal pain. A blood analysis showed anemia, dehydration, and increased levels of LDH and CK ; metabolic acidosis was absent. Based on findings of various imaging methods, right diaphragmatic hernia associated with right massive pleural effusion and deviation of the mediastinum to the left was diagnosed, and an emergency laparotomy was performed. During surgery, we confirmed a ruptured portion about 3 cm in diameter in the right diaphragm, which was just above the right hepatic lobe, through which an about 150-cm long portion of the small intestine had herniated and incarcerated in the right thoracic cavity. The herniated small intestine was easily reduced. There was 2,100 ml of bloody pleural effusion including coagulates in the thoracic cavity. No fragile areas were found at the ruptured portion of the diaphragm, but the rupture extended to the full thickness of the diaphragm. As she had not any apparent episodes of trauma, non-traumatic right diaphragmatic rupture was diagnosed.
We present a case of non-traumatic right diaphragmatic rupture, which is relatively rare, together with a review of the literature.
