title: Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report.
abstract: Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed.
authors.affiliation: Department of General Surgery, Mustafa Kemal University, Faculty of Medicine, Antakya, Hatay, Turkey. veliorhan@hotmail.com
authors.forename: Orhan Veli
authors.initials: OV
authors.lastname: Ozkan
authors.forename: Ersan
authors.initials: E
authors.lastname: Semerci
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yetim
authors.forename: Ramazan
authors.initials: R
authors.lastname: Davran
authors.forename: Guvenc
authors.initials: G
authors.lastname: Diner
authors.forename: Ilhan
authors.initials: I
authors.lastname: Paltaci