Traumatic diaphragmatic hernia with delayed presentation.

BACKGROUND: Traumatic diaphragmatic rupture may occur in patients with thoracoabdominal injuries, and still poses a diagnostic challenge to surgeons. Those patients who survive the events without being diagnosed in the acute phase develop chronic traumatic diaphragmatic hernia. In this study, we reviewed cases of chronic traumatic diaphragmatic hernia managed over the past 35 years.

METHODS: We retrospectively evaluated the clinical courses and radiologic images of 24 cases with chronic traumatic diaphragmatic hernia.

RESULTS: Motor vehicle accident with blunt abdominal trauma was the most important mode of injury. Herniation was more common to the left plural cavity than to the right. The interval between injury and the onset of symptoms ranged from two weeks to 40 years (average, 7.3 years). Vague chest pain, shortness of breath, and bowel obstruction are the most common presentations. Chest radiographic findings suggested the diagnosis of diaphragmatic hernia in 20 patients. Barium study of the gastrointestinal tract was required to confirm the diagnosis. The most common herniated abdominal viscera were the stomach and colon. All patients received thoracotomy with reduction of hernia organs and closure of the diaphragmatic defect. The hospital course was uneventful with no operative mortality.

CONCLUSIONS: Careful interpretation of radiographic images and early surgical intervention are essential in the management of patients with chronic traumatic diaphragmatic hernia. Thoracotomy with reduction of herniated organs can be performed safely with satisfactory results.