Delayed asymptomatic blunt traumatic diaphragmatic hernia: an unusual case report

Main Article Content

Cylla Revata
Mulia Rahmansyah

Abstract

Introduction
Traumatic diaphragmatic hernia (TDH) is uncommon, being encountered in around 0.8%-8% of patients with blunt abdominal trauma. Severe comorbidities such as fractures and thoraco-abdominal or head injuries that accompany TDH, are responsible for poor prognosis and often mask diaphragmatic injury itself. Objective of this case report was to highlight rare blunt TDH case to avoid missed diagnosis leading to complications.


Case description
Sixty seven-year old man presenting with right chest pain without difficulty of breathing after falling from stairs 1 hour before hospital admission. On clinical examination, vitals were stable, but with decreased breath sounds on right lower side of chest. Patient had history of trauma from being crushed by elevator 40 years ago without any proven diaphragmatic injury. Initial erect chest X-ray findings were inhomogeneous opacity shadow on lower right hemithorax suspected to be diaphragmatic hernia and 7th right rib fracture with pleural effusion. Thorax CT scan showed herniated right lobe of liver, gall bladder, and mesenteric fat on right hemithorax causing displacement of mediastinal structures. Patient was diagnosed with delayed TDH and hemothorax caused by newly fractured rib. Patient was referred to a better-equipped facility due to the limited surgical facilities in referring hospital.


Conclusion
Delayed TDHs are not common, but can lead to serious consequences. Blunt TDH occurs more often on left than on right side, in ratio of approximately 3:1. Traumatic diaphragmatic hernia is sometimes diagnosed many years after traumatic event due to latent phase of disease possibly ranging from days to years.

Article Details

How to Cite
Revata, C., & Rahmansyah, M. (2022). Delayed asymptomatic blunt traumatic diaphragmatic hernia: an unusual case report. Universa Medicina, 41(2). Retrieved from https://univmed.org/ejurnal/index.php/medicina/article/view/1255
Section
Case Report
Author Biography

Mulia Rahmansyah, Department of Radiology, Faculty of Medicine, Universitas Trisakti, Jakarta

Department of Radiology,
Murni Teguh Sudirman Jakarta Hospital, Indonesia

References

Lim KH, Park J. Blunt traumatic diaphragmatic rupture: single-center experience with 38 patients. Medicine (Baltimore) 2018;97:e12849. doi: 10.1097/MD.0000000000012849.

Gao J, Du D, Li H, et al. Traumatic diaphragmatic rupture with combined thoracoabdominal injuries: difference between penetrating and blunt injuries. Chin J Traumatol 2015;18:21-6. doi: 10.1016/j.cjtee.2014.07.001.

Furák J, Athanassiadi K. Diaphragm and transdiaphragmatic injuries. J Thorac Dis 2019;11(Suppl 2):S152-S7. doi: 10.21037/jtd.2018.10.76.

Gu P, Lu Y, Li X, Lin X. Acute and chronic traumatic diaphragmatic hernia: 10 years’ experience. PLoS ONE 2019;14:e0226364. https://doi.org/10.1371/journal.pone.0226364.

Davoodabadi A, Fakharian E, Mohammadzadeh M, Abdorrahim Kashi E, Mirzadeh AS. Blunt traumatic diaphragmatic hernia with late presentation. Arch Trauma Res 2012:1:89-92. doi: 10.5812/atr.7593.

Abdelshafy M, Khalifa Y. Traumatic diaphragmatic hernia challenging diagnosis and early management. J Egypt Soc Cardio Thorac Surg 2018;26:219-27. https://doi.org/10.1016/j.jescts.2018.07.001.

Sala C, Bonaldi M, Mariani P, Tagliabue F, Novellino L. Right post-traumatic diaphragmatic hernia with liver and intestinal dislocation. J Surg Case Rep 2017;2017:rjw220. doi: 10.1093/jscr/rjw220.

Chlapoutakis S, Vassileiadis V. Huge post-traumatic diaphragmatic hernia remained asymptomatic for 14 years: a case report. Indian J Thorac Cardiovasc Surg 2018;34:502-5. doi: 10.1007/s12055-018-0658-7.

Domrachev SA, Kucher SA. The giant post-traumatic diaphragmatic hernia: clinical case and literature review. Russian Sklifosovsky J Emerg Med Care 2019;8:325-31. https://doi.org/10.23934/2223-9022-2019-8-3-325-331.

Pakula A, Jones A, Syed J, Skinner R. A rare case of chronic traumatic diaphragmatic hernia requiring complex abdominal wall reconstruction. Int J Surg Case Rep 2015;7:157-60. https://doi.org/10.1016/j.ijscr.2015.01.023.

Taha AY, Hussen WM, Mahdi MB. Diaphragmatic rupture due to blunt trauma: a limited series case report. Egypt Soc Cardio Thorac Surg 2018;37:412-7. doi: 10.4103/ejs.ejs_22_18.

Tjhia J, Noor J. Beyond E-FAST scan in trauma: Diagnosing of traumatic diaphragmatic rupture with bedside ultrasound. Hong Kong J Emerg Med 2017;25:163-5. doi:10.1177/1024907917745234.

Xiao J, Ma L, Li B. Late traumatic diaphragmatic rupture complicated by haemothorax and strangulation of the stomach: a case report. J Int Med Res 2020;48:030006052093086. doi: 10.1177/0300060520930864.

Desir A, Ghaye B. CT of blunt diaphragmatic rupture. RadioGraphics 2012;32:477-98. https://doi.org/10.1148/rg.322115082.

Magu S, Agarwal S, Singla S. Computed tomography in the evaluation of diaphragmatic hernia following blunt trauma. Indian J Surg 2012;74:288–93. doi: 10.1007/s12262-011-0390-7.

Lu J, Wang B, Che X, et al. Delayed traumatic diaphragmatic hernia. Medicine 2016;95:e4362. doi: 10.1097/MD.0000000000004362.