Large bowel obstruction complicating a posttraumatic diaphragmatic hernia.
Posttraumatic diaphragmatic hernia is a rare cause of large bowel obstruction, and can present weeks or years after the initial trauma. Herein, we report the case of a 28-year-old man who presented with signs and symptoms of bowel obstruction nine months after he had a stab wound to his left chest. Chest radiography showed multiple air‑fluid levels in the right upper quadrant, an air-fluid level in the left thoracic cavity and significant free air under the diaphragm. Exploratory laparotomy revealed a contaminated abdomen with perforations in the caecum and proximal transverse colon, and a 4 cm × 4 cm defect in the left posterolateral (septal) aspect of the diaphragm, which was closed with a nonabsorbable suture. Posttraumatic diaphragmatic hernias should be part of the differential diagnosis for patients with bowel obstruction, especially if there is a history of trauma. Radiography is useful in facilitating a quick diagnosis.
Department of Surgery Ward 21, Jinnah Postgraduate Medical Centre, Karachi, Pakistan 75510. uhbhatti88@gmail.com.
Umer Hasan
UH
Bhatti
Surrendar
S
Dawani
D000328:Adult; D044684:Colon, Transverse; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D006549:Hernia, Diaphragmatic, Traumatic / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D014057:Tomography, X-Ray Computed