title: Hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation.
abstract: Here, we present the case of a 53-year-old man with a hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation. On admission, the patient complained of severe acute abdominal pain, with physical examination findings suspicious for a perforated peptic ulcer. Of note, the patient had no history of other medical conditions or recent trauma, and the initial chest radiography and laboratory findings were not specific. A subsequent abdominal computed tomography revealed intrathoracic displacement of the liver, gallbladder, transverse colon and omentum through a right diaphragmatic defect. The patient then underwent an explorative laparotomy that confirmed duodenal ulcer perforation. A primary repair of the duodenal perforation was performed, and the diaphragmatic defect was repaired using a polytetrafluoroethylene patch after the organs were reduced and the cavity irrigated. This particular case proves interesting as right-sided spontaneous diaphragmatic ruptures are very rare and difficult to diagnose. Additionally, the best treatment for such large diaphragmatic defects is still controversial, especially in cases of intrathoracic or intra-abdominal contamination.
authors.affiliation: Se-Jin Baek, Jin Kim, Department of Surgery, Korea University Anam Hospital, Seoul, South Korea.
authors.forename: Se-Jin
authors.initials: SJ
authors.lastname: Baek
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Lee
mesh_terms: D004381:Duodenal Ulcer / Q000150:complications*; D006548:Hernia, Diaphragmatic / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000150:complications*; D012422:Rupture, Spontaneous / Q000209:etiology
keywords: Diaphragmatic rupture; Duodenal ulcer perforation; Hepatothorax; Polytetrafluoroethylene mesh