Delayed diaphragmatic hernia after open trauma with unusual content: Case report

Area of Science:

• Trauma Surgery
• Thoracic Surgery
• Gastroenterology

Background:

• Post-traumatic diaphragmatic hernias are often diagnosed late.
• Left-sided hernias are more common due to diaphragm muscle vulnerability.

Purpose of the Study:

• To report a rare case of a post-traumatic diaphragmatic hernia.
• To highlight the unusual finding of accessory spleens within the hernia sac.

Main Methods:

• A 30-year-old male presented with abdominal pain, vomiting, and dyspnea.
• Diagnostic imaging (X-ray, CT) revealed herniated abdominal organs.
• Surgical repair was performed using combined thoracic and subcostal access.

Main Results:

• The hernia sac contained jejunum, ileum, left colonic flexure, and two accessory spleens.
• Both accessory spleens exhibited advanced ischemia.
• Splenectomy was performed due to compromised vascularity.

Conclusions:

• This is the first reported case of two accessory spleens in a traumatic diaphragmatic hernia.
• Accessory spleens in the thoracic cavity are a possible variation in diaphragmatic hernias.
• The presence of accessory spleens did not significantly alter the surgical approach.