Abstract
Traumatic intrapericardial diaphragmatic hernia with rupture of the diaphragm localized at the pericardial side is very uncommon.
A 51-year-old man was referred to the hospital because of an abnormal sound of the left anterior chest after meals. He had been involved in a serious traffic accident 5 years before and drained left hemothorax for several days. After admission chest CT showed the gastrointestinal tract existed above the diaphragm. Thoracoscopy was tried with a diagnosis of traumatic diaphragmatic hernia, but no diaphragmatic hernia in the left thoracic cavity was seen. It was traumatic intrapericardial diaphragmatic hernia, in which ruptured portion in the diaphragm was localized at the pericardial side. Since the repair of hte hernia was impossible by thoracotomy, he underwent a small left side thoracotomy and the pericardial space was opened. The stomach, omentum and a part of colon were found there and reduced gently. The laceration of the diaphragm was closed directly using interrupted sutures.
CT scan is helpful to confirm the diagnosis of traumatic intrapericardial diaphragmatic hernia, but the correct preoperative diagnosis is very difficult unless pneumopericardium exists in the pericardial space.
