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03 January 2020 : Case report  USA

Traumatic Diaphragmatic Rupture with Transthoracic Organ Herniation: A Case Report and Review of Literature

Challenging differential diagnosis, Management of emergency care, Rare disease

Youssef Shaban1ABCDEF, Adel Elkbuli1ABCDEF*, Mark McKenney12BCDEF, Dessy Boneva12ABCDEF

DOI: 10.12659/AJCR.919442

Am J Case Rep 2020; 21:e919442


BACKGROUND: Diaphragmatic rupture is a rare pathology that reported in less than 0.5% of all trauma cases, with signs and symptoms that can easily be misdiagnosed. Clinicians must maintain a high index of suspicion to correctly diagnose and manage this pathology. We present a rare case of a large diaphragmatic rupture with transthoracic gastric and colon herniation that was successfully repaired, along with a literature review.

CASE REPORT: A 59-year-old woman presented to our Trauma Center after being involved in a motor vehicle collision. She complained of chest and abdominal pain, with decreased breath sounds on the left side. CT imaging revealed discontinuity of the left hemidiaphragm, with intrathoracic herniation of stomach and colon with multiple other injuries. The patient was taken for an emergent laparotomy. The diaphragmatic rupture measured 20 cm in length, with a stellate component. After ensuring complete reduction of the herniated organs, the diaphragmatic defect was primarily repaired. The patient recovered from her injuries and was doing well at last follow-up in the clinic.

CONCLUSIONS: This case highlights the importance of diaphragmatic rupture and its associated intra-abdominal injuries when treating trauma patients. With missed diaphragmatic injuries leading to a potential morbidity rate of 30% and mortality rate as high as 10%, the clinician must have a high index of suspicion to correctly diagnose and manage this pathology in a timely fashion. More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.

Keywords: Abdominal Injuries, Hernia, Diaphragmatic, Traumatic, Rupture, Accidental Injuries, Accidents, Traffic, Colon, Diaphragm, Middle Aged, Stomach, Thoracic Surgery, Video-Assisted



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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923