Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report

Orhan Veli Ozkan,Ramazan Davran,Ersan Semerci,Ilhan Paltaci,Guvenc Diner,Ibrahim Yetim

doi:10.4076/1757-1626-2-6863

Orhan Veli Ozkan, Ramazan Davran + Show 4 more

Open Access

https://doi.org/10.4076/1757-1626-2-6863

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Journal: Cases Journal	Publication Date: Jan 1, 2009
Citations: 20	License type: cc-by

Affiliation: Mustafa Kemal University

Abstract

Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed.

Highlights

Diaphragmatic injury was first reported by Sennertus in 1541 and was repaired successfully by Riolfi for the first time in 1886 [1]
This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later
Mechanism of an injury due to a blunt trauma can be explained by lateral impact that leads to distortion of chest wall, and direct frontal impact resulting in increased intraabdominal pressure; both causing a diaphragmatic injury and visceral herniation

Summary

Introduction

Diaphragmatic injury was first reported by Sennertus in 1541 and was repaired successfully by Riolfi for the first time in 1886 [1]. Abstract Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later.

Results

Conclusion