A tale of traumatic diaphragmatic hernia

Authors

  • Indrajit Anandakannan Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India http://orcid.org/0000-0001-8071-9215
  • Shanthi Ponnandai Swaminathan Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
  • Vikas Kawarat Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
  • Rajeshwari Mani Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
  • Arul Kumar Chinnappan Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
  • kannan R. Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20205918

Keywords:

Trauma, Emergency medicine, Pneumothorax, Traumatic diaphragmatic hernia

Abstract

A traumatic diaphragmatic hernia is uncommon which accounts for 0.8 to 1.6%. In Blunt or penetrating abdominal injury, the patient presents as early or delayed respiratory distress or intestinal obstruction. We present the 55-year old female with a road traffic accident (pedestrian versus two-wheeler) with left-sided chest pain and breathlessness, left shoulder and leg pain referred to our institute. On examination, left hemithorax decreased breath sound and bowel sound was present, chest compression test positive, normal bowel sound in the abdomen, restricted left shoulder movement and abnormal mobility of shaft of left tibia and fibula. A plain X-ray of the chest and abdomen showed bowel shadow in the left hemithorax up to the apex. Computed tomography (CT) of thorax and abdomen shows herniation of stomach, transverse colon, omentum in the left hemithorax with collapsed left lung. A plain X-ray of the left shoulder shows neck of scapula fracture, left leg both bone fracture. Suggesting traumatic diaphragmatic hernia took emergency surgery, laparotomy was made intact stomach, transverse colon, omentum reduced with no injuries, radially placed diaphragmatic rent of size 10 cm × 5.5 cm through which left lung inferior lobe visualized, medial edge of rent close to the pericardial pad of fat. Other solid organs normal, left thoracic drain was fashioned. Rent was closed with interrupted polypropylene with intraabdominal drain. Left leg both bone fracture was done with tibial nailing and left neck of scapula fracture managed conservatively. Abdominal approach is sufficient rather than a thoracoabdominal approach given associated intraabdominal injuries, nowadays minimal access approaches preferred.

Author Biographies

Indrajit Anandakannan, Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Institute of General Surgery,

Madras Medical College and Rajiv Gandhi Government General Hospital,

Chennai, Tamil Nadu, India 600003

Shanthi Ponnandai Swaminathan, Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Institute of General Surgery,

Madras Medical College and Rajiv Gandhi Government General Hospital,

Chennai, Tamil Nadu, India 600003

Vikas Kawarat, Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Institute of General Surgery,

Madras Medical College and Rajiv Gandhi Government General Hospital,

Chennai, Tamil Nadu, India 600003

Rajeshwari Mani, Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Institute of General Surgery,

Madras Medical College and Rajiv Gandhi Government General Hospital,

Chennai, Tamil Nadu, India 600003

Arul Kumar Chinnappan, Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Institute of General Surgery,

Madras Medical College and Rajiv Gandhi Government General Hospital,

Chennai, Tamil Nadu, India 600003

kannan R., Institute of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India

Institute of General Surgery,

Madras Medical College and Rajiv Gandhi Government General Hospital,

Chennai, Tamil Nadu, India 600003

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Published

2020-12-28

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Section

Case Reports