Abstract
BackgroundTraumatic diaphragmatic injuries (TDIs) are relatively uncommon and require surgical repair to prevent or address herniation. Three quarters of TDIs are due to blunt thoraco-abdominal trauma. In blunt TDIs, variable clinical presentations and frequent concurrent life-threatening injuries may hinder early recognition and treatment, leading to diagnostic delays, which may result in technically more challenging repairs. Right-sided blunt TDIs are much less common than left-sided ones, are difficult to visualize on imaging studies, are more frequently associated with other potentially lethal injuries, and tend to present more subtly, so that diagnostic delays are more likely.Case presentationWe report the diagnosis and elective repair of a large right-sided traumatic diaphragmatic hernia resulting from a distant blunt abdominal injury, describing the techniques used to address the challenges presented by the chronic intrathoracic displacement of the entire liver with the gallbladder, as well as the right side of the colon and part of the duodenum.ConclusionsEarly diagnosis of right-sided TDIs can be especially elusive. The management of delayed diaphragmatic hernias can be challenging, but with meticulous planning and a flexible surgical approach, a repair can be achieved resulting in good recovery and low risk of recurrence.
Highlights
Traumatic diaphragmatic injuries (TDIs) are relatively uncommon and require surgical repair to prevent or address herniation
The resulting diaphragmatic hernias may not be detected for years due to their variable anatomical progression and clinical presentation [2]
We present the case of a 35-year-old male with a remote history of a motor vehicle accident who presented with muted symptomatology and was found to have a massive right diaphragmatic hernia, with the entire liver, gallbladder, part of the colon, stomach, omentum, and part of the duodenum displaced into the thorax
Summary
Management of delayed diaphragmatic hernias can be challenging, complex situations may require multidisciplinary coordination, but with meticulous planning and versatile surgical skills, a repair can be achieved resulting in good recovery and low risk of recurrence. Availability of data and materials All data generated or analyzed during this study are included in this manuscript. Ethics approval and consent to participate Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Competing interests All the authors have no competing interests to disclose
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