A delayed presentation of traumatic diaphragmatic hernia in a young male: a unusual case report and comprehensive review of literature

Abstract

Acquired diaphragmatic hernia is typically caused by blunt trauma to the abdomen. It can be challenging to diagnose in acute cases due to a wide range of symptoms. Delayed presentation of traumatic diaphragmatic hernia is uncommon and can lead to respiratory issues or bowel complications like incarceration, perforation, or strangulation. Computed tomography is the preferred diagnostic tool. For acute case, laparotomy is indicated traditionally; however, the choice of surgery is dependent upon the surgeon's expertise and availability of resources.

Keywords: diaphragmatic hernia; incarceration; mesh; perforation.

Figure 1

Chest X-ray PA view showing the herniation of bowel loops into the left hemithorax with collapse of the lower zone of the lung.

Figure 2

CECT abdomen and lower chest in axial section in lung window (A) and coronal section (B) shows herniation of transverse colon and its mesocolon (white arrow) through a defect in left hemidiaphragm into the hemithorax. There is passive atelectasis of the lower lobe of the left lung (black arrow in A).

Figure 3

Intraoperative picture showing the defect in the left diaphragm with the omentum and bowel loops as content.

Figure 4

Intraoperative picture following reduction of hernia. The defect is being closed with prolene.

Figure 5

Intraoperative picture showing composite mesh placement over the defect.

Figure 6

Post-operative picture with no evidence of herniation of bowel content to the left hemidiaphragm.