Research: “A Case of Incarcerated Traumatic Diaphragmatic Hernia”

A 74-year-old woman was admitted to our hospital because of back pain and difficulty of breathing, which started the previous night. She had a history of multiple traumas caused by a traffic accident 4 months prior. She was developing a shock but showed no signs of peritonitis. A computed tomography scan showed dilation of the small intestine and effusion in the right pleural cavity. The diagnosis of delayed traumatic diaphragmatic hernia was confirmed, and emergent laparotomy was performed immediately. The ileum was incarcerated in the right pleural cavity through an orifice approximately 2cm in diameter at the top of the right diaphragm. The orifice was incised and widened enough to pull back the ileum. The necrotic segment was resected and anastomosed. The hernia orifice was closed with a 3-0 Prolene knotted suture. Her postoperative course was uneventful. Obstructive posttraumatic diaphragmatic hernia has been rarely reported, but recently, its incidence has increased in Japan. Obstructive posttraumatic diaphragmatic hernia often requires organ excision and lead to a life-threatening event.