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A Journal on Surgery

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Chirurgia 2013 June;26(3):229-32


language: English

Laparoscopic direct repair of right diaphragmatic hernia presenting 16 years after traumatic event: a case report

Tagliabue F. 1, Mariani P. 1, Codazzi F. 2, Casanova D. 2, Novellino L. 1

1 Department of General Surgery A.O. Bolognini, Seriate, Bergamo, Italy; 2 Department of Radiology, A.O. Bolognini Seriate, Bergamo, Italy


The rupture of diaphragm due to trauma is uncommon. The diaphragmatic hernia may result later with some delay between trauma and diagnosis. Herniation, especially right sided, is associated with high mortality, morbidity of intra-abdominal contents are associated with significant morbility and mortality. Laparoscopic approach is controversial in post-traumatic diaphragmatic hernia. The Authors report a case of 47 years old caucasian female admitted to the emergency department with abruptly addominal pain; in her medical history, traffic accident wiht vertebral fractures (D12-L1) was reported. A chest-abdominal CT scan showed a right diaphragmtic hernia, with i ileal loops in right pleural cavity, left dislocation of liver, right pleural effusiuon, right lung atelectasis, moving to the left of the mediastinum. The patient underwent urgent laparoscopic surgery; the exploration confirmed a large right postero-lateral diaphragmatic defect, with incarcerated and ischemic ileal loops; after adhesionlysis of ileal loops and the drein of pleural effusion, the diaphragmatic defect was repaired with absorbable suture; ischemic ileal loops was resected and removed with laprotomic access. No complications were observed during admission; at 12 months follow-up, no recurrence has been reported. Traumatic diaphragmatic hernia may present years later with life threatening consequences. Missed injuries are commoner on the right side. Early diagnosis and intervention is important because delay in treatment will result in increased morbidity. Laparoscopy is a safe and successful approach to diaphragmatic hernia repair.

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