Herniation Of Organs Research Articles

CHRONIC COUGH CAUSING AN UNEXPECTED COMPLICATION

SESSION TITLE: Medical Student/Resident Signs and Symptoms of Chest Diseases SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Cough is a physiologic defense mechanism to protect airways from foreign material and secretions. It’s one of the most common symptoms responsible of outpatient clinic evaluation and consists of approximately 30 million of visits annually in United States. Can be classified upon the duration on acute (less than 3 weeks), subacute (3 to 8 weeks) and chronic (more than 8 weeks). Sustained cough can be associated with multiple complications including cardiovascular, gastrointestinal, genitourinary, musculoskeletal, ophthalmologic, psychosocial, respiratory and skin complications. The most frequent documented is rib fractures. Other less reported complications include muscle rupture and pneumothorax CASE PRESENTATION: A 72yo woman G3P3A0 with morbid obesity, hypertension, fibromyalgia, diabetes mellitus type 2 and sleep apnea on Bipap with no toxic habits who presents with a chief complaint of dry cough and progressive shortness of breath of approximately 1 year evolution, with multiple visit to primary physician as well as emergency room without improvement of symptoms and treated with antibiotic therapy for pneumonic process. She continued with cough not responsive to medical management developing a tearing abdominal pain that radiate to the back and upper chest associated ecchymosis, worsening of dyspnea, early satiety, left breast pain and an episode of syncope. She denied fever, sputum, or recent trauma. Chest Xray performed on multiple occasions without evidence of abnormality. Chest CT with contrast showed a diaphragmatic rupture with displacement of small and large bowel into left side thoracic cavity causing left pulmonary collapse. Thoracic surgery was performed with placement of intestine on abdominal cavity, correction of diaphragmatic rupture and chest tube placement for pneumothorax. After procedure patient reported resolution of dyspnea. DISCUSSION: Diaphragm is an inspiratory muscle, which contracts during expiratory phase. Valsalva maneuver results in lack coordination of different muscles of expiration, the muscle of the abdominal wall contracts pushing the diaphragm upward whereas the ribs are pushed inward and downward causing diaphragmatic rupture. This complication is caused by thoracic injury in 7% and by thracoabdominal injury in 22% of cases. Herniation of bowel loops into the chest can be a consequence of diaphragmatic rupture, which impairs ventilation and oxygen delivery. The true incidence of abdominal organ herniation due to diaphragmatic rupture is unknown since many cases likely go undiagnosed. Diaphragmatic rupture has an overall mortality rate of 25% as reported by the National Trauma Data Bank. CONCLUSIONS: Due to an increase rate of herniation and strangulation of abdominal organs secondary to diaphragmatic rupture, which can be life threatening and surgical procedure is life saving; physician should be aware of the uncommon complication of cough. Reference #1: Hillenbrand A, Henne-Bruns, D. Cough induced rib fracture, rupture of the diaphragm and abdominal herniation. World Journal of Emergency Surgery 2006, 1:34 DISCLOSURES: No relevant relationships by Aixa Dones Rodriguez, source=Web Response No relevant relationships by Marlene Farinacci Vilaro, source=Web Response No relevant relationships by Ricardo Fernandez, source=Web Response No relevant relationships by Luis Gerena Montano, source=Web Response No relevant relationships by Hernan Gonzalez Monroig, source=Web Response No relevant relationships by Modesto Gonzalez-del Rosario, source=Web Response

Prevalence and antimicrobial susceptibility of asymptomatic bacteriuria among women with pelvic organ prolapse in Abakaliki, South-East Nigeria

BackgroundPelvic organ prolapse (POP) is the herniation of pelvic organs from its anatomical confines, and it is of considerable importance to the practicing gynaecologist in middle and low income countries. It is commonly associated with, urinary tract infection (UTI), both symptomatic and asymptomatic due to anatomical and physiological changes. The aim of this study was to determine the prevalence of asymptomatic bacteriuria among women with pelvic organ prolapse, to know the organisms commonly implicated and the sensitivity pattern.MethodsThis study was conducted among 96 women with POP at the National Obstetric Fistula Centre Abakaliki. A cross sectional descriptive study was done. Standard microbial technique was used to analyze the urine. Data was analysed using the Statistical Package for Social Sciences version 17.ResultsOut of the 96 patients, 76 were found to have asymptomatic bacteriuria giving a prevalence of 79.2%. Nine different bacteria species isolated include E. Coli (34.2%), Streptococcus pneumonia (23.7%), Staphylococcus aureus (7.9%), Proteus Spp (7.9%) others (5.3%). The highest level of microbial sensitivity to the antimicrobials was with Ciprofloxacin.ConclusionsThis study suggests that prevalence of asymptomatic bacteriuria is very high among women with POP. More than 50% of the bacterial isolates were mainly E.coli and Streptococcus pneumonia. The highest level of microbial sensitivity was with ciprofloxacin while the least was with cotrimoxazole.

A fascia lata free flap in pelvic exenteration for Fournier gangrene due to advanced rectal cancer: a case report

BackgroundFournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established. We herein describe the use of a fascia lata free flap in pelvic exenteration for rectal cancer with Fournier gangrene.Case presentationA 66-year-old male who had undergone colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy was referred to our hospital for Fournier gangrene resulting from chemotherapy. Emergency surgical debridement was performed, and the infectious wound around the rectal cancer was treated with intravenous antibiotic agents postoperatively. However, the tumor was exposed by the wound, and exudate persisted. Pelvic exenteration was performed due to tumor infiltration into the bladder and prostate. Tumor resection resulted in a defect in the pelvic floor. A fascia lata free flap (15 × 9 cm) obtained from the left thigh was fixed to the edge of the peritoneum and ileal conduit to close the defect in the pelvic floor and prevent small bowel herniation into the resected space. There was no intraabdominal inflammation or bowel obstruction postoperatively, and outpatient chemotherapy was continued.ConclusionsSurgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer.

Traumatic injuries of the diaphragm: overview of imaging findings and diagnosis.

Injuries to the diaphragm muscle occur in penetrating and severe blunt trauma and can lead to delayed hernia formation. Computed tomography is the mainstay in the diagnosis of these injuries, which may be subtle at presentation. Imaging findings differ between blunt and penetrating trauma. Key features in blunt trauma include diaphragm fragment distraction and organ herniation because of increased intra-abdominal pressure. In penetrating trauma, herniation is uncommon, and the trajectory of the object is critical in making the diagnosis of diaphragm injury in these patients. Radiologists must keep a high index of suspicion for injury to the diaphragm in cases of trauma to the chest or abdomen.

Tissue response to collagen containing polypropylene meshes in an ovine vaginal repair model

Pelvic Organ Prolapse (POP) is the herniation of pelvic organs into the vagina. Despite broad acceptance of mesh use in POP surgical repair, the complication rate is unacceptable. We hypothesized that collagen-containing polypropylene (PP) mesh types could modulate mesh-tissue integration and reduce long-term inflammation, thereby reducing mesh-associated complications. This study compared the long-term tissue response to an unmodified PP mesh and two collagen containing meshes in an ovine model which has similar pelvic anatomy and vaginal size to human. Three commercially available macroporous PP meshes, uncoated PP mesh (Avaulta Solo) (PP), the same textile PP mesh layered with a sheet of cross-linked porcine acellular matrix (Avaulta Plus) (PP-ACM) and a different yet also macroporous PP (Sofradim) mesh coated with solubilized atelocollagen (Ugytex) (PP-sCOL) were implanted in the ovine vagina and tissue explanted after 60 and 180days. The macrophage phenotype and response to implanted meshes, and vascularity were quantified by immunostaining and morphometry. We quantified changes in extracellular matrix composition biochemically and collagen organisation and percentage area around the interface of the mesh implants by Sirius Red birefringence and morphometry. PP-ACM induced a more sustained inflammatory response, indicated by similar CD45+ leukocytes but reduced CD163+ M2 macrophages at 60days (P<0.05). PP-sCOL increased Von Willebrand Factor (vWF)-immunoreactive vessel profiles after 60days. At the micro-molecular level, collagen birefringence quantification revealed significantly fewer mature collagen fibrils (red, thick fibrils) at the mesh-tissue interface than control tissue for all mesh types (P<0.001) but still significantly greater than the proportion of immature (green thin fibrils) at 60days (P<0.05). The proportion of mature collagen fibrils increased with time around the mesh filaments, particularly those containing collagen. The total collagen percent area at the mesh interface was greatest around the PP-ACM mesh at 60days (P<0.05). By 180days the total mature and immature collagen fibres at the interface of the mesh filaments resembled that of native tissue. In particular, these results suggest that both meshes containing collagen evoke different types of tissue responses at different times during the healing response yet both ultimately lead to physiological tissue formation approaching that of normal tissue. Statement of SignificancePelvic organ prolapse (POP) is the descent of the pelvic organs to the vagina. POP affects more than 25% of all women and the lifetime risk of undergoing POP surgery is 19%. Although synthetic polypropylene (PP) meshes have improved the outcome of the surgical treatment for POP, there was an unacceptable rate of adverse events including mesh exposure and contracture. It is hypothesized that coating the PP meshes with collagen would provide a protective effect by preventing severe mesh adhesions to the wound, resulting in a better controlled initial inflammatory response, and diminished risk of exposure. In this study we assessed the effect of two collagen-containing PP meshes on the long-term vaginal tissue response using new techniques to quantify these tissue responses.

Blunt Diaphragmatic Injuries: Pericardial Ruptures

Blunt traumatic diaphragmatic injuries (BTDIs) can be misdiagnosed. Careful evaluation of associated injuries in BTDI is important. In this study, we evaluated treatment options and difficulties in the diagnosis of patients with BTDI. We evaluated ten patients retrospectively with BTDI admitted to our departments, between January 2004 and 2015. Age, gender, trauma type, symptoms, radiological findings, diagnosis time, location and grade of the diaphragmatic injury, surgical type of repair, associated injuries and pericardial rupture, and morbidity and mortality rates were recorded. The mean age of the patients was 46.7years, and all were males. Ninety percent of BTDI was left sided, and 10% was on the right side. The diagnosis was confirmed with chest radiograph in 50% and computed tomography in 70%. Radiological examination revealed hemothorax in 80%, the loss of diaphragmatic shadow in 60%, and visceral organ herniation to the thorax in 60%. Multiple organ injuries were present in 90% of cases. Pericardial rupture seen in 30% was remarkable. Early surgery was performed for eight patients and late surgery for two patients. There were six patients with grade 4 or 5 central diaphragmatic injuries (CDIs). Multiorgan injury was present in all patients developing acute CDI. Multiple organ injury is much higher in patients with severe acute blunt trauma with CDI. Pericardial rupture rate is high in cases with acute BTDI and CDI. Proper diagnosis and early surgical management reduce morbidity and mortality.

Thoracoscopic Repair of a Congenital Diaphragmatic Hernia in a 4 Kg Infant

Abstract Introduction: Congenital diaphragmatic hernia (CDH) is a condition in which the diaphragm fails to form properly, resulting in a defect through which abdominal contents can herniate into the thoracic cavity. A thoracoscopic approach has been suggested for the repair of small CDH (<3 cm) defects, in hemodynamically stable infants, as it allows for improved visualization, avoids the morbidity of an open operation, and has been associated with shorter postoperative courses; shorter time courses on the ventilator postoperatively; and lower postoperative mortality. Identifying which infants have smaller defects can be difficult as they can present with a significant amount of abdominal organ herniation and mediastinal shift. Patient: This patient is a 3-day-old infant male, born at 38 weeks gestational age weighing 3.95 kg, who required intubation at birth due to significant respiratory distress. He was then transferred to our neonatal intensive care unit at 15 hours of life. A chest radiograph showed...

Congenital diaphragmatic hernia in a crossbred piglet: A case report

Congenital diaphragmatic hernia (CDH) is a congenital defect affecting the diaphragm resulting in herniation of organs from abdominal cavity into thoracic cavity. It is a life-threatening condition and a major cause of death due to two complications: pulmonary hypoplasia and pulmonary hypertension. A stillborn male crossbred piglet on necropsy revealed hydrothorax and hydro-peritoneum. Thoracic cavity showed protrusion of parts of the small intestine into the cavity through the right side of the diaphragm, no hernial sac was detected and lungs were under-developed. Liver showed severe congestion and marked enlargement with abnormal lobulation. Cortical surface of both kidneys were rough and granular. Parallely placed double spleen with multiple hemorrhagic areas was noticed. Microscopic examination of kidney showed diffused cortical mononuclear cell infiltration with mild engorgement of medullary capillaries. In lungs, alveolar capillaries were moderately engorged with prominent interlobular septa and severe atelectasis. In liver, multifocal areas of hemorrhages and hydropic degeneration of hepatocytes was noticed. The case was diagnosed as congenital diaphragmatic hernia.

Diaphragmatic rupture presenting with strangulated hernia: Report of two cases

Traumatic rupture of the diaphragm can complicate blunt abdominal trauma. It is rare in our practice, and its diagnosis may be delayed if the index of suspicion is low among emergency room physicians. Imaging studies can easily confirm the diagnosis of diaphragmatic rupture. Herniation of organs and viscera through the diaphragmatic defect occurs commonly, and same may obstruct or strangulate and worsen the outcome. We present two adults with complaints of severe acute abdominal pain and a history of high-speed vehicular trauma whose definitive diagnoses were delayed. The presence of air-fluid levels in the left hemithorax on a chest radiogram and a history of blunt abdominal injury made us arrive at the diagnosis of intestinal obstruction secondary to traumatic diaphragmatic hernia.

A novel approach to mesh revision after sacrocolpopexy.

Pelvic organ prolapse (POP) is the herniation of pelvic organs to or beyond the vaginal walls. POP affects 50% of parous women; of those women, 11% will need surgery based on bothersome symptoms. Transvaginal mesh has been used for vaginal augmentation since the 1990s. Complications from mesh use are now more prominent, and include chronic pelvic pain, dyspareunia, vaginal mesh erosion, and urinary and defecatory dysfunction. Presently, there is no consensus regarding treatment of these complications. Reported herein are two cases of women with defecatory dysfunction and pain after sacrocolpopexy who underwent mesh revision procedures performed with both urogynecologic and colorectal surgery.

Correlation of observed-to-expected total fetal lung volume with intrathoracic organ herniation on magnetic resonance imaging in fetuses with isolated left-sided congenital diaphragmatic hernia.

To assess using fetal magnetic resonance imaging (MRI) the relationship between the position of the stomach as well as the volume of herniation of organs into the thorax, and the observed-to-expected total fetal lung volume (o/e-TFLV), as a measure of pulmonary hypoplasia, in fetuses with isolated left-sided congenital diaphragmatic hernia (LCDH). This was a single-center retrospective study using archived MR images from fetuses > 20 weeks' gestation evaluated for isolated LCDH over an 11-year period between July 2002 and September 2013. We retrieved data on the gestational age at MRI, o/e-TFLV and liver position. Images were also reviewed by a single operator to determine retrospectively the position of the stomach as well as the proportion of the total thorax volume occupied by the herniated fetal liver, stomach and other viscera. Following confirmation of reproducibility, we assessed the correlation of intrathoracic organ volumes and stomach position with o/e-TFLV. The study included 205 fetuses which underwent a total of 259 MR examinations. The reproducibility of organ volume measurements was excellent (intraclass correlation coefficient range, 0.928-0.997). The average time spent to obtain intrathoracic organ volumes ranged from 2.28 to 5.13 min. Of all herniated organ-to-thoracic volume ratios, the liver-to-thoracic volume ratio had the strongest correlation with o/e-TFLV (ρ = -0.429, P<0.0001). Stomach volume did not correlate, although, when categorized by the position and extent of stomach herniation, there was an inverse relationship to o/e-TFLV. No intrathoracic organ-to-thoracic volume ratio was related to gestational age. We observed in fetuses with isolated LCDH an inverse relationship between lung volume and the amount of liver herniated as well as the position of the stomach in the chest.

Thoracoschisis

Introduction: Thoracoschisis is a rare congenital malformation characterized by herniation of intraabdominal contents through a thoracic wall defect. There have been six previously reported cases. We describe our novel approach incorporating closure of the chest wall defect with temporary abdominal wall expansion utilizing a silastic pouch. Case report: A male child born at 29 weeks’ gestation was transferred to our institution for the management of a right anterior chest wall defect with herniation of intraabdominal contents through this defect. The patient was taken to the operating room for reduction of the herniated viscera from the right chest wall defect into the abdomen utilizing a spring-loaded silastic pouch to cover the abdominal viscera. Discussion: The cause of thoracoschisis is unclear. Multiple mechanisms have been proposed for the development of thoracoschisis, including amnionic rupture, vascular injury, and embryologic maldevelopment. In previously reported cases, a majority of patients had associated limb abnormalities. It has been proposed that this association between extremity agenesis/deformity and chest wall defects is related to the limb–body wall complex. In addition, most of the cases reported also had an accompanying diaphragmatic defect, allowing the abdominal viscera to enter the chest and then herniate through the thoracic defect. Conclusion: Overall, thoracoschisis is a very rare congenital abnormality characterized by a chest wall defect with herniation of intra-abdominal organs through this defect. Previously, only six cases have been reported, most of which had an associated limb anomaly or diaphragmatic hernia. Keywords: gastroschisis, limb–body wall complex, thoracoabdominal schisis, thoracoschisis

A giant retroperitoneal lipoma presenting as a sciatic hernia: MRI findings

Sciatic hernia is a rare condition and its clinical diagnosis is uneasy. Herniation of pelvic organs as well as of retroperitoneal neoplasm has been reported in the literature. Sciatica occurs as a result of compression of the sciatic nerve by the herniated sac. We present a case of retroperitoneal lipoma in a patient who had lower leg complaint and describe the imaging findings.

Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury

We aimed to present the frequency of computed tomography (CT) signs of diaphragmatic rupture and the differences between blunt and penetrating trauma. The CT scans of 23 patients with surgically proven diaphragmatic tears (both blunt and penetrating) were retrospectively reviewed for previously described CT signs of diaphragmatic injuries. The overall frequency of CT signs was reported; frequency of signs in right- and left-sided injuries and blunt and penetrating trauma were separately tabulated and statistically compared. The discontinuous diaphragm sign was the most common sign, observed in 95.7% of patients, followed by diaphragmatic thickening (69.6%). While the dependent viscera sign and collar sign were exclusively observed in blunt-trauma patients, organ herniation (P = 0.05) and dangling diaphragm (P = 0.0086) signs were observed significantly more often in blunt trauma than in penetrating trauma. Contiguous injury on either side of the diaphragm was observed more often in penetrating trauma (83.3%) than in blunt trauma (17.7%). Knowledge of the mechanism of injury and familiarity with all CT signs of diaphragmatic injury are necessary to avoid a missed diagnosis because there is variability in the overall occurrence of these signs, with significant differences between blunt and penetrating trauma.

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Introduction: INTRO: Incidence of hiatal hernias (HH) increases with age. Approximately 60% of individuals aged 50 or older have a HH. [1] A giant HH is a hernia that includes at least 30% of the stomach in the chest, although a uniform definition does not exist; most commonly, a giant HH is a type III hernia with a sliding and paraesophageal component [2]. Patients with a giant HH generally present with pain, heartburn or a history of heartburn, dysphagia, vomiting, and anemia. We present a case of giant HH presenting with hematemesis. Case: An 83-year-old non-smoking female patient, with breast cancer who underwent breast biopsy and sentinel node dissection 2 days prior, presented to her local hospital with severe lower chest discomfort, nausea and vomiting with episodes of hematemesis. Initial workup with chest x-ray revealed a giant chest abnormality (figure 1). Pulmonary was consulted to evaluate the giant chest mass. Further review of imaging revealed a giant paraesophageal hiatal hernia with most of her stomach residing in the chest. The stomach was massively dilated and appeared volvulized. She had endoscopy at an outside facility and they drained a liter of fluid from her stomach. A nasogastric tube was placed. However, the stomach remained massively dilated and did not appear to be emptying. She was transferred for further care. Upon transfer, the patient was on a 100% nonrebreather due to difficulty breathing. Her pain and nausea had improved; however, she remained dyspneic. She had mild tenderness in the epigastrium and her white count was elevated at 18,000. She was taken to the operating room by cardiothoracic surgery urgently for reduction of her giant paraesophageal hiatal hernia. On the date of discharge, she was satting 93% on room air. Pathology of the hernia sac revealed mesothelial lined fibrous tissue consistent with hernia sac. Discussion: HH is the protrusion of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. A HH is classified by type as follows: type I indicates sliding hernia; type II, paraesophageal hernia ( 5%); type III, mixed sliding and paraesophageal hernia; and type IV, herniation of additional organs (eg, colon, omentum, spleen). [3] A giant HH is a hernia that includes at least 30% of the stomach in the chest and most commonly is a type III hernia with a sliding and paraesophageal component. This case illustrates the varied presentations of giant HH and the need for early suspicion given the need for surgical intervention. Conclusion: This case illustrates the need to consider giant HH in the presence of hematemesis. Early recognition of this rare entity can lead to early surgical intervention.

Acute kidney injury in hip fracture patients

– Morgagni hernia (MH) is mostly asymptomatic in adult patients. However, a 65-year-old female patient presented with persistent nausea and vomiting and diagnosed MH. Case.– Sixty-five-year-old femalepatient admittedwith complaints of nausea and vomiting. Her physical examination was normal. Only prerenal acute renal failure detected on laboratory examinations. Posteroanterior (PA) chest radiography revealed elevated right hemi-diaphragm. Herniation of intra-abdominal organs into the right hemithorax was detected on the computed tomography (CT). Laparoscopic repair of MH was performed without any complications. Discussion.– Although MH is a congenital disease, the diagnosis is often received during the adulthood. The prevalence increases over the age of 50. Patients generally have no symptoms. Clinical findings of MH begin with an increase in intra-abdominal pressure. In our case, the patient had nausea and vomiting for a week and we considered that MH became symptomatic due to increased intra-abdominal pressure secondary to nausea and vomiting. In conclusion, MH may become symptomatic with intra-abdominal pressure increase in geriatric patients. http://dx.doi.org/10.1016/j.eurger.2013.07.538

Report of three cases of unusual anterior abdominal wall defects in Fallujah General Hospital during the year 2010

Abdominal wall defects occur when the normal sequence of the gastro intestinal tract development is interrupted. Gastroschisis represents a herniation of abdominal contents through a paramedian full-thickness abdominal wall fusion defect without involving the umbilical cord. Evisceration usually only contains intestinal loops and has no surrounding membrane unlike omphalocoele. It is unusual for a newborn with gastroschisis to have other serious birth defects. Neonates with gastroschisis have better prognosis than those with omphalocele. Very rarely is gastroschisis associated with herniation of other organs, and their presence makes the prognosis worse.I report three cases of unusual anterior abdominal wall defects during the year 2010, each having specific associated abnormalities. One was stillborn, and the other two died shortly after delivery.

Laparoscopic Repair of Gastric Herniation After Extrapleural Pneumonectomy for Mesothelioma

Acute herniation of intra-abdominal organs into the chest after extrapleural pneumonectomy is an uncommon but morbid and potentially mortal complication. We report a case of acute diaphragmatic hernia after extrapleural pneumonectomy for mesothelioma repaired laparoscopically. This approach is an alternative to repeated thoracotomy and is a viable option for treatment of this difficult problem with potentially less morbidity.

Laparoscopic repair of post-esophagectomy diaphragmatic hernias using human acellular dermal matrix

Diaphragmatic hernias occur in up to 2% of patients after esophagectomy with gastric pull-up, and the surgical repair in the setting of a previous esophagectomy is a challenge with high complication rates, in particular with regards to the gastric conduit and its critical vascular supply. We describe two cases and the technique of minimally invasive, laparoscopic repair of diaphragmatic defects with organ herniation after esophagectomy using absorbable human acellular dermal matrix.

Delayed presentation of a traumatic diaphragmatic rupture with intrapericardial herniation

Thoracic and abdominal blunt traumas are the major causes of diaphragmatic rupture. These ruptures may be recognized at the time of the initial trauma, but are diagnosed months or even years later during the workup for related symptoms. We present herein a patient who suffered from abdominal pain and dyspnea years after a motor vehicle accident. A chest computed tomography (CT) demonstrated diaphragmatic rupture with intrapericardial herniation of intraabdominal organs. Exploratory laparotomy confirmed the diagnosis. In this report, we describe our management of this unusual diaphragmatic rupture.