A rare case report of perforated viscerothorax in a traumatic diaphragmatic rupture

Diaphragmatic injuries are a consequence of penetrating or blunt thoracoabdominal trauma. Minor injuries are often masked. However, they are easily picked in the presence of diaphragmatic herniations. Delayed presentation is associated with the influx of visceral contents into the thoracic cavity, which may cause strangulation and obstruction. Viscerothorax is a rare complication of diaphragmatic injuries.

A case report of a 25-year-old male patient with a history of penetrating chest injury. He presented to our setting with a sharp abdominal pain and episodes of vomiting that were later accompanied by chest pains and difficulty breathing. A CT scan revealed the presence of a left hemidiaphragmatic injury with a viscerothorax and mediastinal shift to the right side. Surgery was immediately done and with a good postoperative outcome.

Diaphragmatic injuries are still uncommon and are often overlooked in initial presentations. The presence of herniation through the defect prompts early diagnosis. Delayed presentations of these injuries are often affiliated with herniations that may be strangulating or obstructing with more severe complications such as viscerothorax causing tension into the thoracic cavity.

The approach to diaphragmatic injuries at their initial presentation must be handled with an excellent index of suspicion in the evaluation of trauma victims to reduce management delay and avoid detrimental complications in contrast to the involvement of other associated injuries such as haemothorax, rib fractures, and visceral injuries. Early defect diagnosis followed by definitive surgical repair is the most favoured approach.