Delayed Asymptomatic Left Traumatic Diaphragmatic Hernia after Abdominal Stab Wounds

Abstract

Traumatic diaphragmatic hernia (TDH) is sometimes diagnosed many years after the traumatic event. Due to the silent nature of diaphragmatic lesions, the diagnosis is easily missed or difficult. We describe a case of left diaphragmatic hernia, in which the diagnosis was made two years after exploratory laparotomy for an abdominal penetrating stab wounds. The patient had remained asymptomatic until he consulted us to present an abdominal wall hernia. A diaphragmatic hernia was detected incidentally when carrying out the preoperative chest x-ray for the incisional hernia. Abdominal CT scan confirmed the diagnosis. Incarceration of the stomach through the diaphramatic defect was observed after laparotomy. Surgical repair of the diaphragmatic defect and of the incisional hernia with expanded polytetrafluorethylene (ePTFE) and polypropylene mesh, respectively, was performed. The patient was discharged 5 days after the surgical procedures and no complications ocurred. The problems associated with the diagnosis and management of abdominal penetrating stab wounds, as well as the diagnosis and treatment of the delayed left TDH are discussed in the light of this case report.