Four surgical cases of traumatic diaphragm hernia

Yamamoto Yasumichi, Hoshino Daiki, Kosaka Shinji

doi:10.2995/jacsurg.31.763

We studied four surgically treated cases of traumatic hernia of the diaphragm.Case 1: The patient had suffered subarachnoid hemorrhage, liver injury, and a right diaphragm hernia as a result of a fall from a height. Part of the liver protruded into the thoracic cavity through the herniated diaphragm. This was repaired by direct suturing via a thoracotomy on the 10th day after injury.Case 2: The patient had suffered a right diaphragm hernia combined with subdural hematoma and subarachnoid hemorrhage as a result of a traffic accident. The hernia was repaired by direct suturing via a thoracotomy on the 9th day after injury.Case 3: The patient had suffered a right diaphragm hernia, multiple bone fractures, and pulmonary contusion as a result of a fall from a height. The hernia was sutured directly via a thoracotomy on the day after injury, as one day of observation revealed exacerbation of liver invagination into the thoracic cavity.Case 4: The patient had suffered a left diaphragm hernia, subarachnoid hemorrhage, and renal injury in a traffic accident. The hernia was repaired by direct suturing via a thoracotomy on the day of injury.Conclusion: Repair of traumatic diaphragm hernia by direct suturing was possible in all four cases. The time period that elapsed between injury and surgical repair was 10, 9, 1, and 0 days, respectively. Coronal or sagittal imaging using multislice CT allows the accurate diagnosis of traumatic diaphragm hernia. Traumatic hernia of the diaphragm should be repaired as soon as possible because of the likelihood of hernia exacerbation during the observation period.

Four surgical cases of traumatic diaphragm hernia

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