An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: A case report

INTRODUCTION: Post traumatic diaphragmatic hernia is very often missed particularly in polytrauma patients. We present case of an isolated post traumatic diaphragmatic hernia with strangulation, a very rare finding. PRESENTATION OF CASE: A 35 year old man presented with features of intestinal obstruction with past history of a seemingly trivial blunt thoracic injury 15 years back. Findings of X-ray abdomen and chest with high leukocyte count raised suspicion of obstructed diaphragmatic hernia which on exploration revealed obstructed diaphragmatic hernia with gangrenous bowel segment. DISCUSSION: Blunt injury of diaphragm is relatively common and is considered as a marker of severe trauma and it can clinically be occult as other violent injuries may mask and disguise its initial clinical presentation1 resulting in late presentation with obstruction and/or rarely strangulation. An early diagnosis of the condition is prudent to avoid morbidity and mortality associated with late presentations. CONCLUSION: In a patient of intestinal obstruction with history of even trivial throraco-abdominal injury, diagnosis of diaphragmatic hernia should be kept in mind. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd Open access under CC BY-NC-ND license.