Laparoscopic Repair of Acute Traumatic Diaphragmatic Hernia: A Case Report

Abstract

Traumatic diaphragmatic hernia (TDH) is a rare condition resulting from blunt or penetrating thoracoabdominal trauma and is characterized by the protrusion of abdominal organs into the thoracic cavity through a ruptured diaphragm. Due to its diverse clinical presentations, TDH often faces diagnostic challenges. Accurate diagnosis relies on imaging studies and surgical exploration, with surgical intervention being the primary treatment approach. This case presentation highlights a young patient who presented to Saint George Hospital following a blunt thoracoabdominal injury. The patient experienced unexplained dyspnea upon admission, and imaging revealed herniated bowels in the left hemithorax. Laparoscopic exploration confirmed a left hemi-diaphragmatic tear, with the transverse colon, omentum, most of the small bowel, and stomach herniating into the left hemithorax. The patient underwent laparoscopic repair, involving the reduction of the herniated organs into the peritoneal cavity and tension-free primary closure with gastropexy without the use of mesh for reinforcement. The patient's postoperative course was uneventful, and complete recovery was achieved. This case report provides insights into the diagnosis and management of TDH, highlighting the importance of prompt recognition and appropriate surgical intervention in achieving successful outcomes.

Keywords: case study; herniated abdominal organs; laparoscopic repair; thoracoabdominal trauma; traumatic diaphragmatic hernia (tdh).

Figure 1. Chest X-ray showing collapsed left lung with bowel loops seen in the left hemithorax.

Figure 2. Computed tomography of the chest showing herniation of bowels in the left hemithorax.

Figure 3. Laparoscopic image showing the diaphragmatic defect.

Figure 4. Laparoscopic image showing a tension-free primary closure of the diaphragmatic defect with slowly absorbable V-lock sutures without the use of a mesh.

Figure 5. Laparoscopic image showing gastropexy where the stomach was secured to the abdominal wall.

Figure 6. Postoperative chest X-ray after correction of the diaphragmatic defect showing a full expansion of the left lung.