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A rare case of traumatic diaphragmatic hernia presenting twenty years after motor vehicle accident
Mary M. Holohan, BS, Mark A. Thompson, MD
Indiana University School of Medicine
2023-01-31
Presenter: Mary M. Holohan
Affidavit:
Mary M. Holohan, BS, Mark A. Thompson, MD
Director Name: Mark Thompson
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Traumatic diaphragmatic hernia (TDH) is a rare yet well-known complication in patients with blunt or penetrating torso injury. Delayed TDH is a unique subset and can be a missed or classified as lower-priority in an acute setting, resulting in delayed presentation.
Case description: We discuss a case involving a 40-year-old male who presented with progressive chest tightness, nausea, dysphagia, abdominal cramping, and melena, who was subsequently diagnosed with TDH via CT scan. Further investigation of the patient's history revealed motor vehicle accident twenty years prior in which the patient had significant polytrauma including traumatic brain injury. TDH was diagnosed but left untreated at the time prioritizing his other injuries. He failed to follow up. Chronic TDH contents into the right pleural space included the right lobe of the liver, gallbladder, his entire small bowel and mesentery, cecum, ascending colon, and the transverse colon. Initial surgical plan was repair through a right lateral thoracotomy with potential laparotomy was planned. Synchronous manipulation of the bowel and adhesiolysis was mandated to reduce the hernia. Repair was conducted with Gore-tex patch. Intraoperative course was uneventful and the patient recovered uneventfully.
Discussion/significance: Chronic presentation of blunt traumatic diaphragmatic injury is rare and can present many years after initial injury. Repair may depend on severity of symptoms and can require complex surgical decision making with particular attention to approach and potential postoperative complications. Our patient's presentation is particularly unique considering the grossly delayed presentation, right-sided anatomy, and impressive volume of hernia contents.
