ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Latent post traumatic right-sided diaphragmatic hernia with totally herniated liver
Tamer Direk 1, Murat Özkan1, Akın Fırat Kocaay2, Serkan Enön1
1Departments of Thoracic Surgery, Medical Faculty of Ankara University, Ankara, Turkey
2Departments of General Surgery, Medical Faculty of Ankara University, Ankara, Turkey
DOI : 10.5606/tgkdc.dergisi.2016.12867

Posttraumatic diaphragmatic hernia may occur after blunt and penetrating injuries and is usually associated with multiple traumatic injuries. The diagnosis is frequently missed due to lack of typical symptoms.[1] Therefore, radiologic evaluation including computed tomography scans may be crucial for early diagnosis especially in a suspicion of right-sided diaphragmatic rupture.[2]

A 56-year-old female patient who had a blunt thoracic trauma history with right lower rib fractures four years ago was admitted with progressive dyspnea. Computed tomography displayed right hemidiaphragmatic rupture and herniating hepatic flexura, liver and omentum into right hemithorax (Figures 1a-c). Additionally, herniation of gastric fundus even with gall bladder was observed in posterolateral thoracotomy. Diaphragmatic defect was closed via polytetrafluoroethylene 2.0 mm thick soft tissue graft after the reduction of herniated viscus (Figures 2a-c). Patient was discharged uneventfully.

Diaphragmatic injury should be kept in mind in patients with thoracoabdominal trauma. Surgical repair is the treatment of choice in all diaphragmatic hernias and should not be postponed to reduce morbidity and mortality. A written informed consent was obtained from the patient.

Figure 1: (a) Preoperative chest radiograph, (b) coronal computed tomography image showing herniated intraabdominal organs; liver, colon, omentum, (c) postoperative chest radiograph.

Figure 2: (a) Herniated liver, colon and omentum, (b) additional gall bladder seen at tip of forceps, (c) polytetrafluoroethylene graft after reduction of herniated viscus.

Declaration of conflicting interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.