Gastric Perforation Due to Intercostal Drainage: Is it a Clue to Missed Diaphragmatic Hernia?
Asian Journal of Case Reports in Surgery,
Acute post-traumatic diaphragmatic hernia often goes unnoticed resulting in unpalatable and disastrous consequences for the patient. There may be a delay between the injury and the diagnosis which can cause a diagnostic dilemma to the surgeon. A patient with a diaphragmatic hernia due to trauma that has long been forgotten often presents with unrelated symptoms and signs. We report a case of delayed presentation of left traumatic diaphragmatic hernia in a 60-year-old male who presented eight months after blunt trauma. An intercostal drain (ICD) was placed in the left hemithorax to drain a pleural effusion which had resulted in gastric perforation containing food particles in the drain bag. A delay in diagnosis is often the rule in cases of diaphragmatic hernia due to blunt traumas, patients presenting with complications of missed hernia or interventions thereof because of incorrect diagnosis. This case highlights and emphasizes the importance of proper diagnosis in cases of blunt trauma and the astuteness with which history taking and investigations should be pursued before embarking on any therapeutic intervention.
- Diaphragmatic hernia
- blunt trauma
- penetrating trauma
- delayed presentation
How to Cite
Pappas-Gogos G, Karfis E, Kakadellis J, Tsimoyiannis EC. Intrathoracic cancer of the splenic flexure. Hernia. 2007;11(3): 257-259.
Mihos P, Potaris K, Gakidis, et al. Traumatic rupture of the diaphragm: Experience with 65 patients. Injury. 2003; 3:169-72.
Ercan M, Aziret M, Karaman K, Bostancab B, Akoaylu M. Dual mesh repair for a large diaphragmatic hernia defect: An unusual case report. Int J Surg Case Rep. 2016;28:266-269.
DeBlasio R, Maione P, Avallone U, Rossi M, Pigna F, Napolitano C: Late posttraumatic diaphragmatic hernia. A clinical case report. Minerva Chir. 1994;49(5):481-487.
Shah R, Sabanathan S, Mearns AJ, Choudhury AK. Traumatic rupture of diaphragm, Annals of Thoracic Surgery. 1995;60(5):1444–1449.
Hood RM. Traumatic diaphragmatic hernia. Ann Thorac Surg. 1971;12(3):311-324.
Grimes OF. Traumatic injuries of the diaphragm. Diaphragmatic hernia, The American Journal of Surgery. 1974; 128(2):175–181.
Johnson CD. Blunt injuries of the diaphragm, British Journal of Surgery. 1988;7:226–230.
Gelman R, Mirvis SE, Gens D. Diaphragmatic rupture due to blunt trauma: sensitivity of plain chest radiographs, American Journal of Roentgenology. 1991;156(1):51–57.
Bergin D, Ennis R, Keogh C, Fenlon HM, Murray JG. The dependent viscera sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR Am J Roentgenol. 2001;177(5):1137-1140.
Kozak O, Mentes O, Harlak A, et al. Late presentation of blunt right diaphragmatic rupture (hepatic hernia), American Journal of Emergency Medicine. 2008;26(5): 638.e3–638.e5.
Abstract View: 41 times
PDF Download: 13 times