Traumatic diaphragmatic hernia presenting late with non respiratory symptoms

Abstract

A penetrating injury to the chest may cause a diaphragmatic rupture. Presentation can be acute or delayed. Traumatic diaphragmatic hernia (DH) usually presents with symptoms of respiratory compromise. We present a case of a middle-aged man who attended our emergency and diagnosed as acute intestinal obstruction, both clinically and radiologically. A history of stab injury over left chest 10 years back and chest X-ray showed bowel loops in left hemithorax. Diaphragmatic herniation was suspected, although there were no respiratory symptoms on presentation. On laparotomy, a rent of 4 cm × 3 cm was found in the posterolateral aspect of left hemidiaphragm, through which a part of transverse colon and omentum was herniated. The herniated contents were reduced. Closure of the diaphragm followed by loop transverse colostomy was done. The rent was surrounded all around with the ragged diaphragm, which made the possibility of congenital DH unlikely. Thus, a case of traumatic DH was finally diagnosed without respiratory symptoms. With this case we would like to highlight that delayed presentation of traumatic DH may also present with absence of respiratory symptoms.