Giant Traumatic Diaphragmatic Hernia: A Report of Delayed Presentation

Diaphragmatic rupture is an uncommon injury after blunt abdominal trauma. The diaphragmatic defect may not be obvious in imaging studies immediately after the initial injury. Patients may have delayed presentation when the diaphragmatic defect enlarges and allows abdominal content to herniate into the thoracic cavity. Here, we present the case of a 30-year-old man who presented with the emergency department complaining of shortness of breath at rest for two days duration. He reported having shortness of breath for the last five years, but he attributed it to his smoking. The shortness of breath was associated with cough productive and vague abdominal pain. The patient had an unremarkable relevant medical history. He reported having a motor vehicle accident five years ago that was severe but he did not sustain any significant injuries or fractures. Upon examination, the patient appeared in respiratory distress. Respiratory examination revealed diminished air entry on the left hemithorax and the abdominal examination revealed increased generalized tenderness with increased bowel sounds. The patient underwent a thoracic computed tomography scan, which unexpectedly demonstrated a huge left-sided diaphragmatic defect with bowel loops observed to occupy the left hemithorax completely. The patient was stabilized and shifted to emergency laparotomy during which the hernia content was reduced and the defect was closed with a mesh. The patient reported the resolution of his symptoms after the surgery. Intensive chest physiotherapy exercises were performed. After six months of follow-up, the patient remained asymptomatic with no active complaints. The diaphragmatic hernia may have delayed presentations after several years of blunt abdominal trauma. The case highlighted the importance of initial imaging studies after blunt trauma may not identify the diaphragmatic defect.