Strangulated diaphragmatic hernia presenting clinically as pericarditis.

Area of Science:

• Cardiology
• Gastroenterology
• Trauma Surgery

Background:

• Traumatic diaphragmatic hernias (TDH) are rare but serious injuries.
• Pericardial involvement in TDH typically results from direct pericardial trauma.
• Electrocardiographic (ECG) changes indicative of pericarditis are unusual in TDH without direct injury.

Observation:

• A case of strangulation of the transverse colon within a left traumatic diaphragmatic hernia is presented.
• The patient exhibited clinical and electrocardiographic findings consistent with pericarditis.
• Crucially, there was no evidence of direct pericardial trauma.

Findings:

• This case represents a unique instance of pericarditis secondary to internal herniation in a TDH, without direct pericardial injury.
• The strangulated colon likely induced inflammatory or ischemic changes affecting the pericardium.
• ECG changes mimicking pericarditis were observed, emphasizing an indirect mechanism.

Implications:

• Clinicians should consider internal herniation through a traumatic diaphragmatic hernia in patients presenting with chest symptoms, even in the absence of direct thoracic trauma.
• This presentation expands the differential diagnosis for pericarditis, particularly in trauma patients.
• Early recognition and surgical intervention are critical for managing strangulated hernias and associated complications.