Diaphragmatic rupture presenting forty years after injury

Abstract

A previously healthy 59-year-old man was brought to the hospital by ambulance because of a l-day history of severe shortness of breath and abdominal pain, which had progressed until he could no longer lie recumbent or speak. At the age of 18 (1955) he had sustained severe chest trauma in a motorcycle accident after which he had convalesced at home (he refused hospitalization at that time). His pulse was 124/min, blood pressure 90/50, temperature 38”C, respirations 48/min (laboured) and 0, saturation (FiO, = 0.45) was 70%. The abdomen was distended, rigid and silent. The patient was urgently intubated because of respiratory failure and systemic acidosis. Chest radiograph demonstrated the bowel occupying the left hemithorax (Figure 1). An emergency laparotomy was perform&d. The left hemi-diaphragm was found to be ruptured, with multiple adhesions to ribs and spleen. A long loop of strangulated transverse colon was removed from the thorax and resected. The diaphragm was surgically repaired. The patient made a full recovery and remains symptom free 1 year later.