A case of traumatic diaphragmatic hernia that became evident after thoracic drainage

• Published in: The Journal of the Japanese Association for Chest Surgery Vol. 33; no. 5; pp. 573 - 577
• Main Authors: Sakai, Shuto, Tanaka, Yugo, Nakamura, Hayate, Kuroda, Sanae, Hokka, Daisuke, Maniwa, Yoshimasa
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Association for Chest Surgery 15.07.2019
• Subjects: coronal section; image diagnosis; traumatic diaphragm hernia
• ISSN: 0919-0945; 1881-4158
• DOI: 10.2995/jacsurg.33.573

Traumatic diaphragmatic rupture is a relatively rare entity that is caused by major blunt or penetrating trauma. It can result in ileus, respiratory distress, and cardiac insufficiency, and, therefore, should be repaired as soon as possible after diagnosis. However, diagnosis is occasionally difficult in the absence of diaphragmatic hernia. Here, we report a case of traumatic diaphragmatic rupture that was difficult to diagnose. A 76-year-old man who fell from a stepladder, hitting the left side of his chest on the floor, was diagnosed with multiple left rib fractures and left traumatic hemopneumothorax, and advised to rest. However, his hemopneumothorax worsened, and anemia observed on the fourth day after the trauma. A chest drainage tube was placed after he was transferred to our hospital, and he recovered. However, he developed abdominal pain and vomiting in the evening of the same day. He was diagnosed with left diaphragmatic hernia after re-examination with chest computed tomography (CT). Thus, emergency surgery was performed. His diaphragm was repaired after returning the abdominal organs to the abdominal cavity. We reviewed the chest CT scan obtained before placement of the chest drainage tube. We found a pre-existing diaphragmatic rupture and mild herniation on the coronal section of the CT scan, and considered that the diaphragmatic hernia could be attributed to the chest tube placement and thoracic drainage. The diagnosis of traumatic diaphragmatic hernia is occasionally difficult in mild cases, and the coronal section of CT is useful for the early detection of traumatic diaphragmatic hernia.