Ruptured diaphragmatic hernia with grade I splenic injury: A case report

Traumatic diaphragmatic injury (TDI), although rare, is associated with high mortality and morbidity and timely recognition is important.

We present a case of a 44-year-old male who fell from a three-story building and presented with complaints of shortness of breath and chest pain. On examination, his chest compression test and extended focused assessment with sonography in trauma (E-FAST) were positive. Chest X-ray showed loss of diaphragmatic contour, fracture of fifth to eleventh ribs on the left side, and opacities in the left hemithorax. Contrast-enhanced computed tomography of chest, abdomen, and pelvis showed bowel loops over the left hemithorax with grade 1 splenic injury. A diagnosis of ruptured diaphragmatic hernia with grade I splenic injury was made and emergency primary repair of the diaphragm was done via thoracotomy.

Clinical diagnosis of TDI is difficult and can be misdiagnosed as a pneumothorax. In addition, the subtle presentation can often be missed. CT scan of the chest and abdomen is the imaging of choice to reach a diagnosis. Once diagnosed, emergency surgery via laparotomy or thoracotomy is mandatory. Delay in diagnosis can have a fatal consequence or delayed complications which have high mortality.

Diaphragmatic injury should be suspected in all blunt thoracoabdominal traumas, and the presence of this injury should be excluded to prevent late complications. Timely intervention can provide excellent outcomes.