Abstract
Gastric perforation into the thoracic cavity through a diaphragmatic rupture is rare but, when it occurs, patients present in severe distress, with mortality approaching 50%. We present our experience of two rare and unusual cases of traumatic diaphragmatic rupture from penetrating chest injury associated with herniated intrathoracic gastric perforation over a five-year period from January 2015 to December 2020 at the cardiovascular and thoracic surgery department of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Both patients underwent successful surgical repair through standard posterolateral thoracotomy with one having earlier negative exploratory laparotomy. The essence of the paper is to share and discuss the clinical presentation, diagnostic challenges, surgical management and the postoperative care of this very rare complication of traumatic diaphragmatic rupture.
Highlights
We present our experience of two rare and unusual cases of traumatic diaphragmatic rupture from penetrating chest injury associated with herniated intrathoracic gastric perforation over a five-year period from January 2015 to December 2020 at the cardiovascular and thoracic surgery department of the Komfo Anokye Teaching Hospital in Kumasi, Ghana
Traumatic diaphragmatic rupture from either penetrating or blunt thoracic or abdominal injuries is a rare occurrence with incidence of less than 10%
Paswan and colleagues reported of an 18-year-old male who presented with a similar case of traumatic diaphragmatic rupture which was later complicated by gastric herniation and perforation 6 weeks after the trauma [1]
Summary
Traumatic diaphragmatic rupture is usually associated with intrathoracic herniation of intraabdominal organs and intestines. The occurrence of traumatic diaphragmatic rupture with herniated gastric perforation is a rare presentation with few reported cases in literature [1]. The diagnosis is often difficult and a delay in diagnosis frequently results in increased morbidity and mortality. The purpose of this paper is to share our experience in the management of these cases, to sensitize the readers about this rare entity and discuss the diagnostic dilemma along with potential challenges in its management
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