Congenital double diaphragm initially diagnosed as traumatic ruptured diaphragmatic hernia

Abstract

An 11-year old boy, a victim of penetrating stab wound to his chest, presented with severe respiratory distress and dyspnoea. The knife had entered the chest at the rightmid-axillary line, at the level of 7th–8th ribs. He was initially diagnosed of having a right sided pneumothorax and therefore primary resuscitation was performed and a right sided chest tube was inserted. However patient’s severe shortness of breath did not improve. His respiratory rate was 40/min, blood pressure 90/60 mm Hg, and pulse rate was 140/min. Physical examination demonstrated a small (1 cm) laceration on the right chest at the level of 7th intercostal space just below the tip of the scapula. Patient’s chest X-ray revealed intestinal gas above the diaphragmwith chest tubes in the right and left lungs (Fig. 1). The patient was hypoxic (PO2 78.8 mmHg, PCO2 31.5 mm Hg, pH 7.46, HCO3 21.8 mmol/L and O2 saturation of 96.2%), in spite of 10 L of O2. Base on his chest X-ray findings and his unstable clinical features, he was emergently taken to the operating room (OR) with possible diagnosis of traumatic diaphragmatic hernia. During the operation, a double diaphragmwith a large central defect was diagnosed. Hernia repair surgery was done and he was taken to the intensive care unit. His clinical condition progressively improved. Hewas discharged from the hospital 10 days post-surgery.