Abstract
An 87-year-old woman, with a history of right rib fracture 5 years earlier, was admitted to hospital complaining of epigastralgia and dyspnea that had started the previous night. Respiratory sounds were barely audible over the right lung. On chest X-ray, her right lung was almost radio-opaque, with odd niveau-like shadows. CT scan showed dilated small intestine and an effusion in the right pleural cavity. A diaphragmatic hernia was highly suspected. Since she was developing shock and respiratory distress, she underwent emergent laparotomy through an oblique incision in her right upper quadrant. An ileal segment was incarcerated in the right pleural cavity through an orifice about 2 cm in diameter at the top of the right diaphragm. The orifice was incised and widened enough to pull back the ileal segment. As the right lung was inflated, her vital signs improved remarkably. The necrotic segment was resected and anastomosed. The hernia orifice was closed by a running 3-0 monofilament nonabsorbable suture. Her postoperative course was uneventful, though intensive care was required for two days. This case demonstrates that posttraumatic diaphragmatic hernia can have an acute onset following a long dormant period and lead to a life-threatening event.
