Twenty-seven year old man presenting with a strangulated diaphragmatic hernia eight years after the initial injury

Abstract

A 27-year-old man presented with a 5 day history of abdominal pain and distension, with associated constipation and vomiting. He had presented 8 years earlier following a traumatic injury to the left side of the chest, and no diaphragmatic injury was reported at that time. On this admission, a computed tomography scan showed herniation of the splenic flexure of the colon into the left hemithorax. Subsequently, he had an emergency laparotomy for resection, with formation of a loop ileostomy. The various imaging techniques all have advantages and disadvantages when diagnosing a traumatic diaphragmatic hernia. It is the clinician's role to maintain a high index of suspicion when a patient initially presents with trauma where a traumatic diaphragmatic hernia may be a possibility.

Figure 1

Chest x-ray, posterioanterior view showing dense opacity at left base with air fluid level and pleural effusion.

Figure 2

Coronal and sagittal computed tomography scan images showing focal defect (arrows) in the anterior and lateral aspect of left hemidiaphragm, with intrathoracic herniation of colon and omentum resulting in large bowel obstruction.