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Herniation of liver through a ruptured right diaphragm following blunt trauma

Farhad Anoosh, Raza Shariff, Kalyana Nandipati, Rosalind Mariano, Gary Lumbardo, James W. Turner

Am J Case Rep 2009; 10:66-68

ID: 869654


Background: Diaphragmatic rupture remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. Diaphragmatic rupture after thoracoabdominal trauma is uncommon, with a reported incidence ranging from 1% to 3% of patients suffering blunt trauma. Most ruptures are on the left side; with right sided diaphragmatic injury being the subject of a few case reports. Herniation of the liver through a ruptured diaphragm is rarer still.
Case Report: We report a rare case of right sided diaphragmatic rupture with herniation of the liver in a 58 year old polytrauma patient. An initial chest X-ray had only revealed a right hemothorax, which was confirmed on tube thoracostomy. At laparatomy a large tear in the right diaphragm with significant intrathoracic displacement of the liver was encountered. A thoracoabdominal approach was used to reposition the liver and repair the diaphragm.
Conclusions: We discuss the pathophysiology, difficulties associated with diagnosis and treatment options of diaphragmatic injuries.

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