Right-sided posttraumatic diaphragmatic rupture and delayed hepatic hernia.

Abstract

The early diagnosis of posttraumatic diaphragmatic lesions is often difficult which explains the 30 to 50% of non diagnosed cases. This is due to the lack of sensitivity and specificity of the radiographic exams. Missed diaphragmatic lesions results in herniation of abdominal contents into the chest and may be revealed many years from the time of the original trauma. Symptoms such as dyspnea and chronic abdominal complaints are often observed and life-threatening complications, such as visceral strangulation or perforation, contribute to the late morbidity and mortality of the missed injury. Liver herniation is rare and few cases are described in the literature. We report two cases of delayed discovery of the diaphragmatic injury resulting in liver herniation. In one case, there was also an involvement of the duodeno-pancreas. The diagnosis was made 3 and 12 years after the original trauma, respectively, and respiratory embarrassment was the major presenting symptom. The surgical approach was different in the two patients; the first patient was managed by thoracotomy whereas the second patient was treated by laparotomy. The diaphragmatic defect was repaired and reinforced by a prosthetic mesh in the first case. It was closed only by suturing in the second patient. From these two cases, we reviewed the relevant literature and analysed the different approaches for diaphragmatic repair.