Management of left traumatic diaphragmatic hernia complicated by traumatic Stanford type B aortic dissection

Traumatic diaphragmatic hernias are frequently associated with multiple organ injuries caused by high-energy trauma. Herein, we report a case of left traumatic diaphragmatic hernia complicated by traumatic Stanford type B aortic dissection, in which we considered surgical strategies for the timing and approach of diaphragmatic hernia repair.

A 65-year-old man was transported to our hospital following a traffic accident. He was diagnosed with left traumatic diaphragmatic hernia, traumatic Stanford type B aortic dissection, multiple fractures of the left ribs, hemothorax, and pulmonary contusion. Because acute surgery for hernia repair might exacerbate aortic dissection, we initiated conservative treatment for aortic dissection. Respiratory status and ischemia of the herniated organs were monitored carefully. On the day 6, when the aortic dissection was considered stable, we performed diaphragmatic hernia repair. A large surgical field secured by thoracolaparotomy enabled safe surgical techniques for visualization of the aortic wall. Postoperatively, there was no diaphragmatic hernia recurrence, and the aortic dissection remained stable with conservative treatment.

In traumatic diaphragmatic hernia complicated by traumatic Stanford type B aortic dissection, elective surgery via the trans-thoracoabdominal approach may be safe after stabilization of aortic dissection, provided the respiratory condition can be kept stable.