A 37-year-old man was admitted with multiple fractures and on the 5th day after his admission, complained of increasing dyspnea.
Upon auscultation, decreasing breath sound and bowel sound were recognised in the greater part of the left chest.
A chest X-P film revealed that the left lung had collapsed and that there were intestinal gases.
A left side thoracotomy was performed under the diagnosis of traumatic diaphragmatic hernia. The colon, small intestine and spleen were seen in the left thoracic cavity. The left diaphragm was lacerated about 20cm from the central tendon to the antero-lateral end and a 10cm rupture of the pericardium was seen. These two lacerations were not continuous. The spleen also had a small laceration, but the bleeding had stopped.
The rupture of the pericardium was repaired with continuous over and over suture and the diaphragm was repaired with continuous horizontal mattress suture. The postoperative course was uneventful.
