Traumatic diaphragmatic hernia presenting as gastric outlet obstruction: A delayed presentation

Area of Science:

• Trauma Surgery
• Gastroenterology
• Thoracic Surgery

Background:

• Traumatic diaphragmatic hernia (TDH) is an uncommon consequence of significant thoracoabdominal trauma, frequently resulting from road traffic accidents (RTAs).
• Diagnosis of TDH can be challenging and delayed, particularly in polytrauma patients, due to the overshadowing effects of other critical injuries.
• Delayed diagnosis can lead to severe complications, including gastric outlet obstruction, as illustrated by the presented case.

Purpose of the Study:

• To report a case of delayed diagnosis of traumatic diaphragmatic hernia presenting as gastric outlet obstruction.
• To emphasize the critical role of thorough patient history in the timely diagnosis of rare traumatic injuries.
• To illustrate the successful management of a complex traumatic diaphragmatic hernia case.

Main Methods:

• A case study approach was employed, focusing on a 23-year-old male with a history of thoracoabdominal injury.
• Diagnostic evaluation included clinical assessment and imaging (details not specified in abstract).
• Treatment involved laparoscopic repair with mesh placement, followed by thoracotomy for lung decortication due to postoperative complications.

Main Results:

• The patient was successfully treated for gastric outlet obstruction caused by a left-sided traumatic diaphragmatic hernia.
• Laparoscopic repair and mesh placement were effective initial treatments.
• Postoperative thoracotomy was required to manage persistent pleural effusion and lung collapse, with the patient recovering well and remaining asymptomatic.

Conclusions:

• Detailed and meticulous history taking is paramount for diagnosing conditions like traumatic diaphragmatic hernia, especially when symptoms are atypical or masked.
• Prompt diagnosis and appropriate surgical intervention, including laparoscopic techniques and potential mesh use, are key to successful outcomes in TDH.
• Management of TDH may involve complex postoperative care, including procedures like thoracotomy for associated pulmonary complications.