Introduction: Post-traumatic diaphragmatic injury occurs in less than 1% of patients with thoracoabdominal trauma, especially after high-energy injuries, which can break or avulse the diaphragm of their insertions. The late manifestation of this type of injury can result in a hernia of the abdominal organs, a pathology that is associated with a high rate of morbidity and mortality.
Case report: We present the case of a 49-year-old male patient, who begins symptoms 5 days before admission, characterized by abdominal pain located in the epigastrium and right hypochondrium, absence of bowel movements, and vomiting; a chest X-ray was performed, showing the presence of colonic handles in the right pulmonary field; so it was necessary to perform laparoscopic cure of the diaphragmatic hernia, and later an exploratory laparotomy. Obtaining the postoperative finding of grade IV right diaphragmatic hernia.
Conclusion: A high suspicion rate is required to diagnose this entity; a late diagnosis is associated with greater morbidity and mortality; the ideal therapeutic approach will depend on the degree of injury and the experience of the surgeon.
Williams M. UpToDate [Internet]. Recognition and management of diaphragmatic injury in adults; 2021. [cited 2022 Apr 4]. Available from: https://www.uptodate.com/contents/recognition-and-management-of-diaphragmatic-injury-in-adults?search=hernia%20diafragm%C3%A1tica%20en%20adulto&source=search_result&selectedTitle=1~101&usage_type=default&display_rank=1#H654387
Rashid F, Chakrabarty M, Singh R, et al. A review on delayed presentation of diaphragmatic rupture. World J Emerg Surg 2009;4(1):32. DOI: 10.1186/1749-7922-4-32
Rouvière H, Delmas A, Delmas V. Anatomía humana. 11th ed. Barcelona: Masson; 2010.
Furák J, Athanassiadi K. Diaphragm and transdiaphragmatic injuries. J Thorac Dis 2019;11(Suppl 2):S152–S157. DOI: 10.21037/jtd.2018.10.76
Strug B, Noon GP, Beall AC Jr. Traumatic diaphragmatic hernia. Ann Thorax Surg 1974;17(5):444–449. DOI: 10.1016/S0003-4975(10)656
Fair KA, Gordon NT, Barbosa RR, et al. Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis. Am J Surg 2015;209(5):864–869. DOI: 10.1016/j.amjsurg.2014.12.023
National Trauma Data Base. American College of Surgeons 2000–2004. [accessed on 2005 Jan 1]. Available from: https://ntdbdatacenter.com/
Degiannis E, Levy R, Sofianos C, et al. Diaphragmatic herniation after penetrating trauma. Br J Surg 1996;83(1):88–91. DOI: 10.1002/bjs.1800830128
Guner A, Bekar Y, Kece C, et al. Delayed enterothorax and hepatothorax due to missed right-sided traumatic diaphragmatic rupture. Am J Emerg Med 2012;30(1):263.e7–263.e10. DOI: 10.1016/j.ajem.2010.11.016
Valdés MAS, Polhamus MA, Villa MLM, et al. Traumatic diaphragmatic hernia: case report. Medwave 2013;13(2):e5636–e5636. DOI: 10.5867/medwave.2013.02.5636
Collia E. Diafragma. Cirugía Digestiva, F. Galindo; 2009. II–295. p. 1–15. www.sacd.org.ar
Filosso PL, Guerrera F, Sandri A, et al. Surgical management of chronic diaphragmatic hernias. J Thorac Dis 2019;11(Suppl 2):S177–S185. DOI: 10.21037/jtd.2019.01.54
Mitchell DC, Lea RE. Late presentation of diaphragmatic hernia: a missed diagnosis. BMJ 1988;297(6650):734–735. DOI: 10.1136/bmj.297.6650.734
Carter BN, Giuseffi J, Felson B. Traumatic diaphragmatic hernia. Am J Roentgenol Radium Ther 1951;65(1):56–72. Available from: https://pubmed.ncbi.nlm.nih.gov/14799666/
Williams M, Carlin AM, Tyburski JG, et al. Predictors of mortality in patients with traumatic diaphragmatic rupture and associated thoracic and/or abdominal injuries. Am Surg 2004;70(2):157–162. Available from: https://pubmed.ncbi.nlm.nih.gov/15011920/
Wei F, Li Y. Successful management requiring multidisciplinary cooperation between seven departments for a large right-sided incarcerated traumatic diaphragmatic hernia: a case report and review of literature. AME Case Rep 2020;4:10. DOI: 10.21037/acr.2020.03.02
Lu J, Wang B, Che X. Delayed traumatic diaphragmatic hernia: a case-series report and literature review. Medicine 2016;95(32):e4362. DOI: 10.1097/MD.0000000000004362
Hammer MM, Raptis DA, Mellnick VM, et al. Traumatic injuries of the diaphragm: overview of imaging findings and diagnosis. Abdom Radiol (NY) 2017;42(4):1020–1027. DOI: 10.1007/s00261-016-0908-3
Hanna W, Ferri L, Fata P, et al. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg 2008;85(3):1044–1048. DOI: 10.1016/j.athoracsur.2007.10.084
McDonald AA, Robinson BRH, Alarcon L, et al. Evaluation and management of traumatic diaphragmatic injuries: a practice management guideline from the Eastern Association for the surgery of trauma. J Trauma Acute Care Surg 2018;85(1):198–207. DOI: 10.1097/TA.0000000000001924
Gu P, Lu Y, Li X, et al. Acute and chronic traumatic diaphragmatic hernia: 10 years’ experience. PLoS One 2019;14(12):e0226364. DOI: 10.1371/journal.pone.0226364
Silva GP, Cataneo DC, Cataneo AJM. Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis. Acta Cir Bras 2018;33(1):49–66. DOI: 10.1590/s0102-865020180010000006
