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. 2013;4(5):446-8.
doi: 10.1016/j.ijscr.2013.02.006. Epub 2013 Feb 24.

An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: A case report

Shailesh Kumar  1 , Santosh Kumar, Shubhendu Bhaduri, Sumit More, Priyadarshi Dikshit
Affiliations

An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: A case report

Shailesh Kumar et al. Int J Surg Case Rep. 2013.

Abstract

Introduction: Post traumatic diaphragmatic hernia is very often missed particularly in polytrauma patients. We present case of an isolated post traumatic diaphragmatic hernia with strangulation, a very rare finding.

Presentation of case: A 35 year old man presented with features of intestinal obstruction with past history of a seemingly trivial blunt thoracic injury 15 years back. Findings of X-ray abdomen and chest with high leukocyte count raised suspicion of obstructed diaphragmatic hernia which on exploration revealed obstructed diaphragmatic hernia with gangrenous bowel segment.

Discussion: Blunt injury of diaphragm is relatively common and is considered as a marker of severe trauma and it can clinically be occult as other violent injuries may mask and disguise its initial clinical presentation(1) resulting in late presentation with obstruction and/or rarely strangulation. An early diagnosis of the condition is prudent to avoid morbidity and mortality associated with late presentations.

Conclusion: In a patient of intestinal obstruction with history of even trivial throraco- abdominal injury, diagnosis of diaphragmatic hernia should be kept in mind.

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Figures

Fig. 1
Fig. 1
X ray abdomen and chest.
Fig. 2
Fig. 2
Intra operative view. (A) Herniated transverse colon; (B) herniated small intestine; (C) left hemi-diaphragmatic defect; (D) stomach; (E) gangrenous portion of herniated small intestine.
Fig. 3
Fig. 3
Intra operative view. (A) Herniated small intestine; (B) herniated transverse colon; (C) left hemi-diaphragmatic defect.
See this image and copyright information in PMC

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