Management problems of coincident traumatic diaphragmatic hernia and myocardial infarction

A 32 year old man suffered a traffic accident, and was admitted to the Emergency Department with closed left-sided chest injury. Subsequent standard procedures revealed a traumatic rupture of the diaphragm and resulting hernia. The surgical treatment of these lesions was without complications. Postoperative monitoring showed a persistent elevation of the ST segment, which was considered to be due to the original trauma. After 14 days the patient was discharged, but at a precautionary follow-up two months later coronary angiography revealed severe ischaemic disease and ventricular aneurysm. The diagnostic and management problems of cases such as this are discussed. It is concluded that one should not be tempted by the youth or apparent good health of the patient to take short-cuts at any stage.