A patient with a traumatic right diaphragmatic hernia occurring 4 years after sustaining injury--statistical observations of a delayed diaphragmatic hernia caused by uncomplicated injury in Japan.
We describe our experience with a patient in whom a traumatic right diaphragmatic hernia developed 4 years after sustaining injury and review cases of delayed diaphragmatic injury reported in Japan. The patient was a 28-year-old man who sustained a severe contusion of the right epigastric region and fractured a right rib in a traffic accident in September 1992. In August 1996, the patient presented with shortness of breath on effort or after meals. A chest roentgenogram revealed intestinal gas in the right side of the thoracic cavity. A right diaphragmatic hernia was diagnosed on the basis of a gastrointestinal series, and the patient was operated on. The hernial orifice extended anteriorly from the central tendon in an 11:00 direction and measured 11 x 6 cm. The small intestine, right side of the colon, and liver were herniated. A total of 297 cases of blunt traumatic diaphragmatic hernia were reported in Japan between 1981 and 1996, including 47 cases (left side, 32 cases; right side, 15 cases) of delayed diaphragmatic hernia, defined as occurring one month or more after injury. Diaphragmatic hernia should be considered as a possible diagnosis in patients with abnormal shadows in the thoracic region who have recently sustained injury or who have a past history of injury.
Maekawa
T
T
Department of Surgery of Juntendo University, Izunagaoka Hospital, Shizuoka, Japan.
Yabuki
K
K
Satou
K
K
Mishima
G
G
Tamasaki
Y
Y
Watabe
S
S
Shirota
S
S
D000007:Abdominal Injuries / Q000150:complications; D000063:Accidents, Traffic; D000328:Adult; D005260:Female; D006549:Hernia, Diaphragmatic, Traumatic / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications