title: Intrathoracic transverse colon and small bowel infarction in a patient with traumatic diaphragmatic hernia. Case report and review of the literature.
abstract: OBJECTIVE
  Herniation of abdominal contents through the diaphragm has been described for a variety of diaphragmatic defects and may be secondary to diaphragmatic injury, either traumatic or iatrogenic. The sequelae of diaphragmatic hernia include intestinal obstruction, strangulation, gangrene and, eventually, perforation. The aim of this study was to report a case of intrathoracic infarction of transverse colon and two meters of small bowel in a patient with traumatic diaphragmatic hernia.
  
  
  METHODS
  Young man with past history of blunt abdominal trauma presented abdominal pain with dyspnea. An exploratory laparotomy was performed. The esophageal hiatus was normal but a 4.5 cm rent was discovered in the posterior leaf of the left hemidiaphragm. Passing through the defect was the transverse colon and a proximal small bowel. The herniated transverse colon and jejunum were massively dilated with evidence of infarction. Transverse colectomy and resection of two meters of jejunum with direct anastomosis were performed. Following bowel removal, diaphragm was directly repaired without graft. Finally, a chest tube was placed in the left hemithorax.
  
  
  RESULTS
  Postoperative course was uneventful and he recovered without complications. He was discharged from hospital 10 days after surgery.
  
  
  CONCLUSIONS
  Surgeons, internists and emergency medicine personnel should be aware of the possibility of diaphragmatic hernia in patients with a known history of abdominal trauma. Though uncommon, strangulation of colon and small bowel through a rent in diaphragm should be considered when there is radiologic evidence of herniation.
authors.affiliation: Department of General Surgery, Hôtel-Dieu de France Hospital, Alfred Naccache Street, Beirut, Lebanon. dbabboud@yahoo.fr
authors.forename: Bassam
authors.initials: B
authors.lastname: Abboud
authors.forename: Joe Bou
authors.initials: JB
authors.lastname: Jaoude
authors.forename: Moussa
authors.initials: M
authors.lastname: Riachi
authors.forename: Ghassan
authors.initials: G
authors.lastname: Sleilaty
authors.forename: Georges
authors.initials: G
authors.lastname: Tabet
mesh_terms: D000328:Adult; D003082:Colectomy; D003106:Colon / Q000098:blood supply*; D006549:Hernia, Diaphragmatic, Traumatic / Q000150:complications* / Q000601:surgery; D006801:Humans; D007238:Infarction / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D007421:Intestine, Small / Q000098:blood supply*; D008297:Male; D014949:Wounds, Nonpenetrating / Q000150:complications