Missed Diaphragmatic Rupture and Progressive Hepatothorax, 26 Years after Blunt Injury

Abstract

Background: Cases of blunt diaphragmatic rupture are not as common as other thoracoabdominal injuries and may pose a diagnostic challenge. Depending upon the size of the right hemidiaphragmatic rupture, herniation of liver may be partial, as progressive hepatothorax. The diagnosis of progressive hepatothorax coincides with the onset of the first symptoms of herniation. Case Study: In the patient presented here, the interval between the original injury and the onset of symptoms related to the herniation of the abdominal cavity organs in the thorax was 26 years. Herniation of abdominal organs into the thorax was apparently rather slow and asymptomatic. The first symptoms, 26 years after trauma, included epigastric pain, meteorism, nausea, and vomiting, and all of them were due to gastrothorax and elongated gaster. These symptoms were nonspecific and therefore interpreted as acute alcoholic gastritis. With deterioration of the patient's condition, they were subsequently interpreted as subileus due to the strangulation of a portion of the elongated and dilated stomach. Conclusion: Laparoscopy proved to be the most reliable diagnostic method in this case.