Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report

Abstract

Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed.

Figure 1.

(a) X-ray of the abdomen and thorax showed multiple air-filled structures in the left hemithoracic area, widening of the intercostal space and displacement of the mediastinum to the right. Notice the continuity of the colonic gas shadow that can be clearly seen on abdomen and left hemithorax. (b) Abdominal CT section showed a thickened posterior diaphragm. Colonic segments can be seen just anterior to the diaphragm.

Figure 2.

(a) Intraoperative view of diaphragmatic rupture. (b) Intraoperative appearance of colonic perforation and necrosis.