Large bowel obstruction complicating a posttraumatic diaphragmatic hernia.

Area of Science:

• Trauma Surgery
• Gastroenterology
• Thoracic Surgery

Background:

• Posttraumatic diaphragmatic hernia (PDH) is a rare complication following chest trauma.
• It can manifest as bowel obstruction weeks or years after the initial injury.
• Timely diagnosis and surgical intervention are critical for patient outcomes.

Observation:

• A 28-year-old male presented with signs of bowel obstruction nine months post-stab wound to the left chest.
• Chest radiography revealed intra-abdominal air-fluid levels and free air under the diaphragm.
• Exploratory laparotomy identified large bowel perforations and a diaphragmatic defect.

Findings:

• The patient had a 4 cm × 4 cm defect in the left posterolateral diaphragm.
• Perforations were noted in the cecum and proximal transverse colon.
• The diaphragmatic defect was successfully repaired with nonabsorbable sutures.

Implications:

• PDH should be considered in the differential diagnosis of bowel obstruction, particularly in trauma patients.
• Radiographic imaging plays a vital role in the rapid diagnosis of PDH.
• Prompt surgical management of PDH is essential to prevent complications such as bowel perforation.