Laparoscopic Repair of an Acute Traumatic Diaphragmatic Hernia: Clinical Case

Traumatic diaphragmatic rupture is uncommon, life threatening and remains a diagnostic and radiographic challenge. Diagnosis is frequently delayed, which may result in a late intervention with a potential catastrophic outcome. We report a case of an acute diaphragmatic laceration in a 40-year-old woman, with a personal history of bipolar disease, admitted on the emergency department after falling from a nine-meter building. During initial evaluation, the plain chest radiograph showed multiple rib fractures associated with a significant left pneumothorax. It also showed an elevated left diaphragm with a suspicious gastric shadow in the left hemithorax. Computed tomography confirmed the diagnosis of a left-sided diaphragmatic laceration and the patient was advised surgical intervention. During laparoscopy, a 7 cm rupture of the left hemi-diaphragm with herniation of the stomach was identified. The hernia was reduced laparoscopically and the defect repaired with interrupted, non-absorbable, sutures. The patient had an uneventful recovery and remained well at a 3-month follow-up visit. Emergency repair of the diaphragm is usually performed via a thoracotomy or/and laparotomy. However, if the patient is hemodynamically stable and major organ injuries have been excluded, a laparoscopic approach can be considered safe and effective.