CASE OF TRAUMATIC DIAPHRAGMATIC HERNIA INVOLVING THE LIVER OCCURRED AFTER RECEIVING A STABBED WOUND IN THE CHEST WALL

Abstract

We experienced an extremely rare case of left-sided traumatic diaphragmatic herina involving the left hepatic lobe as a part of hernia content which occurred about 4 years after receiving a stabbed wound. The case involved a 49-year-old woman. There was a previous history of receiving a stabbed wound in the anterior thoracic region for suicide purpose which was conservatively treated in December 1990. In September 1994 the patient was seen at the hospital because of an upper abdominal pain and vomiting. A simple chest X-ray film revealed pleural effusion. Upper gastrointestinal series and chest CT visualized a protrusion of the upper portion of the gastric body in the left thoracic cavity. Based on her previous history and results of examinations, she was operated on transabdominally under a diagnosis of traumatic diaphragmatic hernia. At laparotomy, the hernia opening was 4×4 cm in size; the hernia was located in the left anterior lateral portion of the central tendon of the diaphragm; and the middle portion of gastric body and a part of the left hepatic lobe were incarcerated. The protruded gastric body appeared good in color, but the liver necrosed and so the portion was excised. The hernia opening was closed in one layer suture. Postoperative course was uneventful.