A CASE OF TRAUMATIC DIAPHRAGMATIC HERNIA PRESENTED WITH INTESTINAL OBSTRUCTION DUE TO INTESTINAL NECROSIS

Abstract

We experienced a case of traumatic diaphragmatic hernia presented with intestinal obstruction 9 days after a blunt thoraco-abdominal injury and multiple fracture of the lower extremities.
A 64-year-old man was transferred to the hospital in shock state because he was bruised all over at a traffic accident. Chest CT scan revealed right hemopneumothorax and left homothorax, and a drainage was performed. The patient also had multiple fracture of the lower extremities. Open reduction was carried out after his general condition was improved. From around 9 th hospital day, abdominal distension, nausea and vomiting were recognized. Thoraco-abdominal x-ray films on the next day visualized dilated small intestine and gaseous distention. Traumatic diaphragmatic hernia was suspected and an emergency operation was performed. Upon laparotomy, a hiatus was present in the left diaphragm posterolaterally and the greater omenturn and transverse colon incarcerated into the thoracic cavity which were reduced by maneuver method. In addition, necrosis of the ileum about 10 cm in length was found that was thought a probable cause of intestinal obstruction and an excision of the intestine was performed.
It is etiologically inferred that traumatic injury of the intestine necrosed with time to develop intestinal obstruction that caused an increase in abdominal pressure resulting in prolupse of intentine through the injured diaphragm; and eventually delayed diaphragmatic hernia occurred.