Delayed presenting traumatic diaphragmatic hernia: four case reports

Kim, Euitae

Abstract

A traumatic diaphragmatic hernia is a rare combined problem involving injuries to the thorax and abdomen that may not be diagnosed at the time of injury. Surgical management is mandatory when the patient displays any signs of bowel strangulation due to the herniation because a herniated bowel has a very high risk of necrosis or perforation. Four patients were diagnosed with delayed traumatic diaphragmatic hernia 14 to 96 months after injury. In two patients, the diaphragmatic injury was missed at the time of injury. Reduction and diaphragm repair surgery were performed. One diaphragm was repaired with artificial mesh. Traumatic diaphragmatic injury is caused by a blunt or penetrating injury to the abdomen or thorax. After migration of the intra-abdominal contents into the chest, a narrow herniation defect can disturb the bowel circulation and passage of bowel contents. Early detection and reduction, and repair surgery are mandatory for patients with a delayed presentation of complicated traumatic diaphragmatic hernia. Any patient with injury around the thorax or upper abdomen should be examined carefully considering the possibility of diaphragmatic hernia. Even if diaphragmatic injuries are not found in the initial evaluation, a radiology examination in a short period of time can correct the missed diagnosis of traumatic diaphragmatic hernia.