Abstract
Motor vehicle collisions (MVC) cause more than one million deaths annually and an estimated 20-50 million significant injuries. They can cause blunt and penetrating trauma. Blunt diaphragmatic rupture is generally associated with multiple severe injuries due to the high force needed to cause the injury. Traumatic diaphragmatic rupture (TDR) is normally identified during advance trauma life support (ATLS) secondary survey, after other more serious injuries are identified in the primary survey. We present a case of a patient who was involved in a MVC with multiple injuries, which were treated appropriately, prior to identification and treatment of a severe right-sided diaphragm injury. Imaging showed only a persistent right hemidiaphragm elevation. Intra-operative findings consisted of complete herniation of the liver with a Grade IV, 30 cm, right-sided diaphragmatic rupture. The herniated liver was repositioned and the diaphragm primarily repaired without complication. This case highlights a severe injury from a blunt MVC and rapid successful recovery of the patient once appropriately treated.
Highlights
Blunt traumatic diaphragmatic rupture (TDR) is caused by high energy damage force and is associated with multiple life-threatening injuries [1]
TDR is more commonly diagnosed on the left side (80%), likely attributed to the liver protecting the right side of the diaphragm (20%)
TDR is estimated to occur in approximately 1%-7% of patients with major blunt trauma [1]
Summary
Blunt traumatic diaphragmatic rupture (TDR) is caused by high energy damage force and is associated with multiple life-threatening injuries [1]. Computed tomography (CT) of the chest, abdomen and pelvis demonstrated the following: a right-sided traumatic hemothorax, a small right-sided traumatic pneumothorax with severe right-sided pulmonary contusion; a Grade 3 right renal laceration; a Grade 4 liver laceration without evidence of active arterial extravasation; multiple fractures including the right humerus, right fourth rib, inferior sternum, right S1 hemisacrum, S4 sacral segment and right superior and inferior pubic rami. On routine CXR comparison, it was noted that the patient had persistent elevation of the right hemi-diaphragm since tube thoracostomy placement (Figure 1). The patient underwent a video-assisted thoracoscopy on suspicion of a diaphragmatic injury It was noted upon entry into the thoracic cavity, that the liver was almost completely herniated into the chest. The patient was followed up after three weeks in the thoracic surgery outpatient clinic He reported feeling well at the visit with only mild chest pains that intermittently radiated to his right shoulder. The patient was deemed recovered at this time and was instructed to follow up as need
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
