Double Blow Injury: Diaphragmatic Rupture with Gastric Perforation Following Blunt Trauma

Abstract

Diaphragmatic injury is an unusual life threatening complication of blunt trauma abdomen. However, a double blow injury occurring simultaneously such as diaphragmatic hernia and gastric injury is a rare injury. The association of gastric perforation along with diaphragmatic injury increases the mortality as well as morbidity manifold as compared to an isolated diaphragmatic injury. Traumatic diaphragmatic injury has variable clinical presentation ranging from pain in abdomen to respiratory distress and pneumonia. Preoperative diagnosis of diaphragmatic injury is quite demanding and often it goes undetected only to be found later intraoperatively. Although chest X-ray is still the best screening imaging modality to detect the diaphragmatic hernia but occasionally, especially for right-sided diaphragmatic injury, computed tomography and magnetic resonance imaging may be required to detect it in early stage. Here, we report a case of diaphragmatic hernia with gastric perforation sustaining blunt trauma in an 18 years old, young adult. Only a few cases of double blow injury with perforation of the diaphragm and stomach are reported in the literature. We aim to report this case because a prompt intervention with high degree of suspicion is the key to success in managing diaphragmatic hernia with gastric perforation following blunt trauma injury to the abdomen.