Abstract
Spontaneous diaphragmatic rupture (SDR) is a very rare surgical emergency. A possible explanation for SDR might be a sudden increase of intra-abdominal pressure due to intense coughing, physical exercise, vomiting, or delivery. A 66-year-old male patient presented with recurrent coughing, dyspnoea, and intermittent fever. Although initial CT scan was inconspicuous, a follow-up CT scan revealed SDR of the left hemidiaphragm with herniation of the left colonic flexure, stomach, and parts of the greater omentum. Emergency laparotomy confirmed SDR. The ruptured anterior-lateral part of the diaphragm was closed, and additionally, a composite mesh was applied to reinforce the suture line. A right-sided hemicolectomy with primary anastomosis had to be performed. SDR is a rarity and can cause exceptional clinical features that may lead to inaccurate diagnosis and therapeutic delay. Therefore, of paramount importance, medical practitioners need to be aware of this important differential diagnosis for spontaneous dyspnoea or tachypnea.
Highlights
Rupture of the left diaphragm and herniation of intraabdominal organs like the stomach, spleen, and colon are mostly caused by blunt or penetrating abdominal trauma
Spontaneous chest pain and shortness of breath or tachypnea should lead to computer tomographic imaging to rule out differential diagnoses like pulmonary embolism, pneumonia, spontaneous pneumothorax, or Spontaneous diaphragmatic rupture (SDR)
We present a case of SDR with herniation of the stomach, liver, and left colonic flexure after severe coughing, and a review of the literature
Summary
Rupture of the left diaphragm and herniation of intraabdominal organs like the stomach, spleen, and colon are mostly caused by blunt or penetrating abdominal trauma. In an analogy to blunt abdominal trauma, it is hypothesized that the sudden rise of intra-abdominal pressure leads to the rupture of the weakest part, which is the diaphragm as in the presented case. We present a case of SDR with herniation of the stomach, liver, and left colonic flexure after severe coughing, and a review of the literature. The patient complained about constipation for three days and back pain as well as lower abdominal pain He mentioned falling out of his bed during sleep the night before admission. The CT scan was repeated and showed a left diaphragmatic rupture with herniation of the stomach, spleen, and left colonic flexure (Figures 2 and 3). An extended right hemicolectomy had to be performed with an ileotransversostomy to restore intestinal continuity
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